401k Plan data: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN plan

PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 401k Plan overview

Plan Name	PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN
Plan identification number	502

PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Other welfare benefit cover

401k Sponsoring company profile

PRS HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name: PRS HOLDINGS, INC.

Employer identification number (EIN): 330353433

NAIC Classification: 237310
NAIC Description: Highway, Street, and Bridge Construction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01 JAMES MUNOZ JAMES MUNOZ 2018-07-26
502 2016-01-01 KEVIN FAUST KEVIN FAUST 2017-07-11
502 2015-01-01 KEVIN FAUST KEVIN FAUST 2016-07-26
502 2014-06-01 DIANE ROGERS
502 2014-06-01 DIANE ROGERS 2015-07-08
502 2013-06-01 DIANE ROGERS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2017-01-01	JAMES MUNOZ	JAMES MUNOZ	2018-07-26
502	2016-01-01	KEVIN FAUST	KEVIN FAUST	2017-07-11
502	2015-01-01	KEVIN FAUST	KEVIN FAUST	2016-07-26
502	2014-06-01	DIANE ROGERS
502	2014-06-01		DIANE ROGERS	2015-07-08
502	2013-06-01	DIANE ROGERS

Plan Statistics for PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN

401k plan membership statisitcs for PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN

Measure Date Value
2017: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
2016: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 151
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 151
2015: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 151
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 151
2014: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 151
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 151
Number of retired or separated participants receiving benefits 2014-06-01 0
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 151
2013: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 125
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 151
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-06-01 0
Total participants 2013-06-01 151

Measure	Date	Value
2017: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
2016: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	151
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	151
2015: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	151
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	151
2014: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	151
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	151
Number of retired or separated participants receiving benefits	2014-06-01	0
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	151
2013: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	125
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	151
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-06-01	0
Total participants	2013-06-01	151

Form 5500 Responses for PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN

2017: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	Yes
2014-06-01	This submission is the final filing	No
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: PAVEMENT RECYCLING SYSTEMS, INC. EMPLOYEE ASSISTANCE PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	First time form 5500 has been submitted	Yes
2013-06-01	Submission has been amended	No
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 )

Policy contract number

002192

Policy instance

Insurance contract or identification number	002192
Number of Individuals Covered	151
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $228
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $4,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $228
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN INSURANCE SVCS OF CA

MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 )

Policy contract number

2192

Policy instance

Insurance contract or identification number	2192
Number of Individuals Covered	151
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $147
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $2,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $147
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN INS SVC OF CA INC

MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 )

Policy contract number

2192

Policy instance

Insurance contract or identification number	2192
Number of Individuals Covered	151
Insurance policy start date	2014-06-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $175
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $3,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $175
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN INS SVC OF CA INC

MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 )

Policy contract number

2192

Policy instance

Insurance contract or identification number	2192
Number of Individuals Covered	151
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $159
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $3,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $159
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN INS SVC OF CA INC.

Potentially related plans

PAVEMENT RECYCLING, INC. 401(K) PROFIT SHARING PLAN [EIN = 382795008]

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Company Name:	PRS HOLDINGS, INC.
Employer identification number (EIN):	330353433
NAIC Classification:	237310
NAIC Description:	Highway, Street, and Bridge Construction