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| Plan Name | 2K CLEVELANDER HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | 2K CLEVELANDER LLC CLEVELANDER HOTEL |
| Employer identification number (EIN): | 263688836 |
| NAIC Classification: | 721110 |
| NAIC Description: | Hotels (except Casino Hotels) and Motels |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-02-01 | TOM BURCHETT | |||
| 501 | 2016-02-01 | TOM BURCHETT | |||
| 501 | 2015-02-01 | TOM BURCHETT |
| Measure | Date | Value |
|---|---|---|
| 2017: 2K CLEVELANDER HEALTH AND WELFARE PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-02-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 80 |
| Total of all active and inactive participants | 2017-02-01 | 80 |
| 2016: 2K CLEVELANDER HEALTH AND WELFARE PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-02-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 127 |
| Total of all active and inactive participants | 2016-02-01 | 127 |
| 2015: 2K CLEVELANDER HEALTH AND WELFARE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-02-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 124 |
| Total of all active and inactive participants | 2015-02-01 | 124 |
| 2017: 2K CLEVELANDER HEALTH AND WELFARE PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Submission has been amended | No |
| 2017-02-01 | This submission is the final filing | No |
| 2017-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-02-01 | Plan is a collectively bargained plan | No |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: 2K CLEVELANDER HEALTH AND WELFARE PLAN 2016 form 5500 responses | ||
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Submission has been amended | No |
| 2016-02-01 | This submission is the final filing | No |
| 2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-02-01 | Plan is a collectively bargained plan | No |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: 2K CLEVELANDER HEALTH AND WELFARE PLAN 2015 form 5500 responses | ||
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | First time form 5500 has been submitted | Yes |
| 2015-02-01 | Submission has been amended | No |
| 2015-02-01 | This submission is the final filing | No |
| 2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-02-01 | Plan is a collectively bargained plan | No |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 678781 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| AVMED HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 95263 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 122990/1/2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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