401k Plan data: CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN plan

CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN
Plan identification number	501

CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

CHESTER LIMITED MIDWEST, LLC has sponsored the creation of one or more 401k plans.

Company Name: CHESTER LIMITED MIDWEST, LLC

Employer identification number (EIN): 383336773

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-12-01

Plan Statistics for CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN

401k plan membership statisitcs for CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN

Measure Date Value
2021: CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-12-01 88
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 100
Number of retired or separated participants receiving benefits 2021-12-01 0
Number of other retired or separated participants entitled to future benefits 2021-12-01 0
Total of all active and inactive participants 2021-12-01 100

Measure	Date	Value
2021: CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	88
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	100
Number of retired or separated participants receiving benefits	2021-12-01	0
Number of other retired or separated participants entitled to future benefits	2021-12-01	0
Total of all active and inactive participants	2021-12-01	100

Form 5500 Responses for CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN

2021: CHESTER LIMITED MIDWEST, LLC DBA JOHNSTONE SUPPLY WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	First time form 5500 has been submitted	Yes
2021-12-01	Submission has been amended	No
2021-12-01	This submission is the final filing	No
2021-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-12-01	Plan is a collectively bargained plan	No
2021-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )

Policy contract number

10005564

Policy instance

Insurance contract or identification number	10005564
Number of Individuals Covered	131
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $29,863
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
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
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 $497,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,886
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3

ALLIANCE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60134 )

Policy contract number

10005565

Policy instance

Insurance contract or identification number	10005565
Number of Individuals Covered	62
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $15,887
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
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
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 $264,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,242
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3

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Company Name:	CHESTER LIMITED MIDWEST, LLC
Employer identification number (EIN):	383336773