401k Plan data: TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN plan

TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN
Plan identification number	501

TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

TAYLOR EMPLOYEE LEASING LLC has sponsored the creation of one or more 401k plans.

Company Name: TAYLOR EMPLOYEE LEASING LLC

Employer identification number (EIN): 475592828

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-10-01 LINDSAY TAYLOR-OPRITZA 2021-04-06
501 2018-10-01 LINDSAY TAYLOR-OPRITZA 2021-04-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-10-01	LINDSAY TAYLOR-OPRITZA	2021-04-06
501	2018-10-01	LINDSAY TAYLOR-OPRITZA	2021-04-08

Plan Statistics for TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN

Measure Date Value
2019: TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 175
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 174
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 174
Number of employers contributing to the scheme 2019-10-01 0
2018: TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 100
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 175
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 0
Total of all active and inactive participants 2018-10-01 175
Number of employers contributing to the scheme 2018-10-01 0

Measure	Date	Value
2019: TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	175
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	174
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	174
Number of employers contributing to the scheme	2019-10-01	0
2018: TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	100
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	175
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	0
Total of all active and inactive participants	2018-10-01	175
Number of employers contributing to the scheme	2018-10-01	0

Form 5500 Responses for TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN

2019: TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2018: TAYLOR EMPLOYEE LEASING LLC HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	First time form 5500 has been submitted	Yes
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

240108

Policy instance

Insurance contract or identification number	240108
Number of Individuals Covered	197
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $29,722
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $794,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,722
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

536757

Policy instance

Insurance contract or identification number	536757
Number of Individuals Covered	174
Insurance policy start date	2019-10-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,006
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $59,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,493
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

240108

Policy instance

Insurance contract or identification number	240108
Number of Individuals Covered	188
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $25,586
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $667,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,586
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

536757

Policy instance

Insurance contract or identification number	536757
Number of Individuals Covered	175
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $17,602
Total amount of fees paid to insurance company	USD $6,079
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $149,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,243
Amount paid for insurance broker fees	6079
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	TAYLOR EMPLOYEE LEASING LLC
Employer identification number (EIN):	475592828
NAIC Classification:	441110
NAIC Description:	New Car Dealers