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| Plan Name | ONESOURCE STAFFING LLC |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ONESOURCE STAFFING LLC |
| Employer identification number (EIN): | 461670790 |
| NAIC Classification: | 561300 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-01-01 | MILTON CLEGG | 2023-10-16 | MILTON CLEGG | 2023-10-16 |
| Measure | Date | Value |
|---|---|---|
| 2022: ONESOURCE STAFFING LLC 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 17 |
| Total of all active and inactive participants | 2022-01-01 | 17 |
| 2022: ONESOURCE STAFFING LLC 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| SELF FUNDED FIRST HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||
| Policy contract number | 71433400 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) | |||||||||||||||||||||
| Policy contract number | PAI-M-2938700 | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
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| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) | |||||||||||||||||||||
| Policy contract number | PAI-L-2938700 | ||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||
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