401k Plan data: THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN plan

THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN
Plan identification number	501

THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Vision
Temporary disability (accident and sickness)
Long-term disability cover
Other welfare benefit cover
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

THIRD AND OAK CORP DBA TREYTON OAK TOWERS has sponsored the creation of one or more 401k plans.

Company Name: THIRD AND OAK CORP DBA TREYTON OAK TOWERS

Employer identification number (EIN): 310986103

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-06-01 GEORGETTA WRIGHT 2024-12-30
501 2020-06-01 GEORGETTA WRIGHT 2022-02-09
501 2020-06-01 GEORGETTA WRIGHT 2023-01-10
501 2019-06-01 GEORGETTA WRIGHT 2021-03-08
501 2018-06-01 GEORGETTA WRIGHT 2020-01-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-06-01	GEORGETTA WRIGHT	2024-12-30
501	2020-06-01	GEORGETTA WRIGHT	2022-02-09
501	2020-06-01	GEORGETTA WRIGHT	2023-01-10
501	2019-06-01	GEORGETTA WRIGHT	2021-03-08
501	2018-06-01	GEORGETTA WRIGHT	2020-01-27

Form 5500 Responses for THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN

2023: THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-06-01	Type of plan entity	Single employer plan
2023-06-01	Plan funding arrangement – Insurance	Yes
2023-06-01	Plan benefit arrangement – Insurance	Yes
2020: THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	Submission has been amended	Yes
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes
2019: THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2018: THIRD & OAK CORP. D/B/A TREYTON OAK TOWERS HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	First time form 5500 has been submitted	Yes
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 )

Policy contract number

838853

Policy instance

Insurance contract or identification number	838853
Number of Individuals Covered	65
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $2,335
Total amount of fees paid to insurance company	USD $34
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

838853

Policy instance

Insurance contract or identification number	838853
Number of Individuals Covered	64
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $22,249
Total amount of fees paid to insurance company	USD $4,239
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $613,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ASQN

Policy instance

Insurance contract or identification number	GLUG0ASQN
Number of Individuals Covered	111
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $1,161
Total amount of fees paid to insurance company	USD $328
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $7,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ASQN

Policy instance

Insurance contract or identification number	GUC 0ASQN
Number of Individuals Covered	42
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $5,520
Total amount of fees paid to insurance company	USD $1,567
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ASQN

Policy instance

Insurance contract or identification number	GLTD0ASQN
Number of Individuals Covered	11
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $675
Total amount of fees paid to insurance company	USD $198
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ASQN

Policy instance

Insurance contract or identification number	GVTL0ASQN
Number of Individuals Covered	30
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Other welfare benefits provided	VOL LIFE, VOL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E4453536

Policy instance

Insurance contract or identification number	E4453536
Number of Individuals Covered	69
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $4,798
Total amount of fees paid to insurance company	USD $700
Other welfare benefits provided	ACCIDENT, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $27,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ASQN

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E4453536

Policy instance

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

700730

Policy instance

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 )

Policy contract number

838853

Policy instance

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

838853

Policy instance

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

700730

Policy instance

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

KY2160

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ASQN

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E4453536

Policy instance

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 )

Policy contract number

744011

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0ASQN

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ASQN

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E4453536

Policy instance

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

700730

Policy instance

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

744011

Policy instance

Potentially related plans

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Company Name:	THIRD AND OAK CORP DBA TREYTON OAK TOWERS
Employer identification number (EIN):	310986103
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities