401k Plan data: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN plan

THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 401k Plan overview

Plan Name	THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN
Plan identification number	507

THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

THE AMBASSADOR HOLDING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: THE AMBASSADOR HOLDING COMPANY

Employer identification number (EIN): 470684278

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2022-01-01
507 2021-01-01 TYLER JUILFS 2022-08-11
507 2020-01-01 TYLER JUILFS 2021-08-13
507 2019-01-01 TYLER JUILLFS 2020-10-08
507 2018-01-01 TYLER JUILFS 2019-07-31
507 2017-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
507	2022-01-01
507	2021-01-01	TYLER JUILFS	2022-08-11
507	2020-01-01	TYLER JUILFS	2021-08-13
507	2019-01-01	TYLER JUILLFS	2020-10-08
507	2018-01-01	TYLER JUILFS	2019-07-31
507	2017-01-01

Plan Statistics for THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN

401k plan membership statisitcs for THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN

Measure Date Value
2022: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 366
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 0
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 0
2021: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 345
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 366
Total of all active and inactive participants 2021-01-01 366
2020: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 329
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 345
Total of all active and inactive participants 2020-01-01 345
Total participants 2020-01-01 345
2019: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 342
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 329
Total of all active and inactive participants 2019-01-01 329
Total participants 2019-01-01 329
2018: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 342
Total of all active and inactive participants 2018-01-01 342
Total participants 2018-01-01 342
2017: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 314
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 165
Total of all active and inactive participants 2017-01-01 165
Total participants 2017-01-01 165

Measure	Date	Value
2022: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	366
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	0
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	0
2021: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	345
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	366
Total of all active and inactive participants	2021-01-01	366
2020: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	329
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	345
Total of all active and inactive participants	2020-01-01	345
Total participants	2020-01-01	345
2019: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	342
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	329
Total of all active and inactive participants	2019-01-01	329
Total participants	2019-01-01	329
2018: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	342
Total of all active and inactive participants	2018-01-01	342
Total participants	2018-01-01	342
2017: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	314
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	165
Total of all active and inactive participants	2017-01-01	165
Total participants	2017-01-01	165

Form 5500 Responses for THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN

2022: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 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	Yes
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
2021: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: THE AMBASSADOR HOLDING COMPANY FLEX LTD PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
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

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

800700

Policy instance

Insurance contract or identification number	800700
Number of Individuals Covered	337
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $865
Total amount of fees paid to insurance company	USD $135
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	Yes
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 $10,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $865
Insurance broker organization code?	3
Amount paid for insurance broker fees	135
Additional information about fees paid to insurance broker	FEES

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

800700

Policy instance

Insurance contract or identification number	800700
Number of Individuals Covered	366
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $984
Total amount of fees paid to insurance company	USD $154
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $984
Insurance broker organization code?	3
Amount paid for insurance broker fees	154
Additional information about fees paid to insurance broker	FEES

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

800700

Policy instance

Insurance contract or identification number	800700
Number of Individuals Covered	345
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $992
Total amount of fees paid to insurance company	USD $155
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	Yes
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 $11,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $992
Insurance broker organization code?	3
Amount paid for insurance broker fees	155
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

800700

Policy instance

Insurance contract or identification number	800700
Number of Individuals Covered	329
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $913
Total amount of fees paid to insurance company	USD $143
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	Yes
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 $11,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $913
Amount paid for insurance broker fees	143
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

800700

Policy instance

Insurance contract or identification number	800700
Number of Individuals Covered	342
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,018
Total amount of fees paid to insurance company	USD $159
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	Yes
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 $12,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,018
Amount paid for insurance broker fees	159
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

800700

Policy instance

Insurance contract or identification number	800700
Number of Individuals Covered	165
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $995
Total amount of fees paid to insurance company	USD $171
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	Yes
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 $12,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $995
Amount paid for insurance broker fees	171
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	TIM OLSON INC

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Company Name:	THE AMBASSADOR HOLDING COMPANY
Employer identification number (EIN):	470684278
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities