401k Plan data: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN plan

OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN
Plan identification number	002

OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

OLIVE AVENUE STAFFING, LLC has sponsored the creation of one or more 401k plans.

Company Name: OLIVE AVENUE STAFFING, LLC

Employer identification number (EIN): 475614074

NAIC Classification: 721110
NAIC Description: Hotels (except Casino Hotels) and Motels

Additional information about OLIVE AVENUE STAFFING, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2015-11-18

Company Identification Number: L15000195143

Legal Registered Office Address: 1201 Hays Street

Tallahassee

32301

More information about OLIVE AVENUE STAFFING, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2018-01-01
002 2017-01-01 AIMEE MANGOLD
002 2016-01-01 AIME

Plan Statistics for OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN

Measure Date Value
2018: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 218
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 282
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 49
Total of all active and inactive participants 2018-01-01 331
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 331
Number of participants with account balances 2018-01-01 199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 167
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 191
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 24
Total of all active and inactive participants 2017-01-01 215
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 215
Number of participants with account balances 2017-01-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 123
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 25
Total of all active and inactive participants 2016-01-01 148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 148
Number of participants with account balances 2016-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0

Measure	Date	Value
2018: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	218
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	282
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	49
Total of all active and inactive participants	2018-01-01	331
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	331
Number of participants with account balances	2018-01-01	199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	167
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	191
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	24
Total of all active and inactive participants	2017-01-01	215
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	215
Number of participants with account balances	2017-01-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	123
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	25
Total of all active and inactive participants	2016-01-01	148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	148
Number of participants with account balances	2016-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0

Financial Data on OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN

Measure	Date	Value
2018 : OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$26,630
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$523,695
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$271,508
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$242,813
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$632,165
Value of total assets at end of year	2018-12-31	$1,713,741
Value of total assets at beginning of year	2018-12-31	$1,434,924
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$28,695
Total interest from all sources	2018-12-31	$6,677
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$143,492
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$318,824
Participant contributions at end of year	2018-12-31	$30,772
Participant contributions at beginning of year	2018-12-31	$17,506
Participant contributions at end of year	2018-12-31	$10,662
Participant contributions at beginning of year	2018-12-31	$5,092
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$87,949
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$26,630
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$252,187
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,687,111
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,434,924
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$1,658,836
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$1,405,403
Interest on participant loans	2018-12-31	$1,554
Interest earned on other investments	2018-12-31	$5,123
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$4,920
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$3,137
Net investment gain/loss from pooled separate accounts	2018-12-31	$-115,147
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$225,392
Employer contributions (assets) at end of year	2018-12-31	$8,551
Employer contributions (assets) at beginning of year	2018-12-31	$3,786
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$242,813
Contract administrator fees	2018-12-31	$28,695
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	BERKOWITZ POLLACK BRANT
Accountancy firm EIN	2018-12-31	592742314
2017 : OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$508,826
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$58,156
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$38,879
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$331,259
Value of total assets at end of year	2017-12-31	$1,434,924
Value of total assets at beginning of year	2017-12-31	$984,254
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$19,277
Total interest from all sources	2017-12-31	$2,746
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$120,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$205,695
Participant contributions at end of year	2017-12-31	$17,506
Participant contributions at beginning of year	2017-12-31	$19,218
Participant contributions at end of year	2017-12-31	$5,092
Participant contributions at beginning of year	2017-12-31	$4,219
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$450,670
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,434,924
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$984,254
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$1,405,403
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$956,756
Interest on participant loans	2017-12-31	$784
Interest earned on other investments	2017-12-31	$1,962
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$3,137
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,438
Net investment gain/loss from pooled separate accounts	2017-12-31	$174,821
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$125,564
Employer contributions (assets) at end of year	2017-12-31	$3,786
Employer contributions (assets) at beginning of year	2017-12-31	$2,623
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$38,879
Contract administrator fees	2017-12-31	$19,277
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	BERKOWITZ POLLACK BRANT
Accountancy firm EIN	2017-12-31	592742314
2016 : OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$584,920
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$447,041
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$47,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$36,703
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$350,635
Value of total assets at end of year	2016-12-31	$984,254
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$11,004
Total interest from all sources	2016-12-31	$824
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	No
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$191,717
Participant contributions at end of year	2016-12-31	$19,218
Participant contributions at end of year	2016-12-31	$4,219
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$47,427
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$399,334
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$984,254
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$956,756
Interest on participant loans	2016-12-31	$810
Interest earned on other investments	2016-12-31	$14
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,438
Net investment gain/loss from pooled separate accounts	2016-12-31	$95,582
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$111,491
Employer contributions (assets) at end of year	2016-12-31	$2,623
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$36,703
Contract administrator fees	2016-12-31	$11,004
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	BERKOWITZ POLLACK BRANT
Accountancy firm EIN	2016-12-31	592742314

Form 5500 Responses for OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN

2018: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS 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 funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
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 funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: OLIVE AVENUE STAFFING, LLC RETIREMENT SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP30225 /FV43

Policy instance

Insurance contract or identification number	GP30225 /FV43
Number of Individuals Covered	199
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,050
Total amount of fees paid to insurance company	USD $482
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?	Yes
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	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
Commission paid to Insurance Broker	USD $8,050
Insurance broker organization code?	4
Amount paid for insurance broker fees	482
Additional information about fees paid to insurance broker	MARKETING ALLOWANCE

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP30225 /FV43

Policy instance

Insurance contract or identification number	GP30225 /FV43
Number of Individuals Covered	103
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,750
Total amount of fees paid to insurance company	USD $2,172
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?	Yes
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	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
Commission paid to Insurance Broker	USD $5,750
Insurance broker organization code?	4
Amount paid for insurance broker fees	1626
Additional information about fees paid to insurance broker	TPA SUBSIDY
Insurance broker name	MERRILL LYNCH LIFE AGENCY INC

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Company Name:	OLIVE AVENUE STAFFING, LLC
Employer identification number (EIN):	475614074
NAIC Classification:	721110
NAIC Description:	Hotels (except Casino Hotels) and Motels

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2015-11-18
Company Identification Number:	L15000195143
Legal Registered Office Address:	1201 Hays Street Tallahassee 32301