401k Plan data: E. T. MACKENZIE OF FLORIDA HEALTH PLAN plan

E. T. MACKENZIE OF FLORIDA HEALTH PLAN 401k Plan overview

Plan Name	E. T. MACKENZIE OF FLORIDA HEALTH PLAN
Plan identification number	501

E. T. MACKENZIE OF FLORIDA HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) 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.

401k Sponsoring company profile

E. T. MACKENZIE OF FLORIDA, INC. has sponsored the creation of one or more 401k plans.

Company Name: E. T. MACKENZIE OF FLORIDA, INC.

Employer identification number (EIN): 383204096

NAIC Classification: 237990
NAIC Description: Other Heavy and Civil Engineering Construction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan E. T. MACKENZIE OF FLORIDA HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-06-01 MICHAEL S. MARKS 2019-11-12
501 2017-06-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-06-01	MICHAEL S. MARKS	2019-11-12
501	2017-06-01

Plan Statistics for E. T. MACKENZIE OF FLORIDA HEALTH PLAN

401k plan membership statisitcs for E. T. MACKENZIE OF FLORIDA HEALTH PLAN

Measure Date Value
2018: E. T. MACKENZIE OF FLORIDA HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-06-01 100
Total number of active participants reported on line 7a of the Form 5500 2018-06-01 96
Total of all active and inactive participants 2018-06-01 96
2017: E. T. MACKENZIE OF FLORIDA HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-06-01 106
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 100
Total of all active and inactive participants 2017-06-01 100

Measure	Date	Value
2018: E. T. MACKENZIE OF FLORIDA HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	100
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	96
Total of all active and inactive participants	2018-06-01	96
2017: E. T. MACKENZIE OF FLORIDA HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	106
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	100
Total of all active and inactive participants	2017-06-01	100

Form 5500 Responses for E. T. MACKENZIE OF FLORIDA HEALTH PLAN

2018: E. T. MACKENZIE OF FLORIDA HEALTH PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes
2017: E. T. MACKENZIE OF FLORIDA HEALTH PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	First time form 5500 has been submitted	Yes
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

B2398

Policy instance

Insurance contract or identification number	B2398
Number of Individuals Covered	4
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $1,589
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	BLUESCRIPT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,589
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

B2398

Policy instance

Insurance contract or identification number	B2398
Number of Individuals Covered	92
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $31,409
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,409
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

B2398

Policy instance

Insurance contract or identification number	B2398
Number of Individuals Covered	4
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $1,480
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $818
Insurance broker organization code?	3
Insurance broker name	RAYMOND CHOI

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

B2398

Policy instance

Insurance contract or identification number	B2398
Number of Individuals Covered	96
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $31,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	18616
Insurance broker organization code?	3
Insurance broker name	RAYMOND CHOI

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Company Name:	E. T. MACKENZIE OF FLORIDA, INC.
Employer identification number (EIN):	383204096
NAIC Classification:	237990
NAIC Description:	Other Heavy and Civil Engineering Construction