401k Plan data: OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN plan

OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	503

OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover

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 HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-10-01 AIMEE MANGOLD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2015-10-01	AIMEE MANGOLD

Plan Statistics for OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2015: OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 189
Total of all active and inactive participants 2015-10-01 0
Total participants 2015-10-01 0

Measure	Date	Value
2015: OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	189
Total of all active and inactive participants	2015-10-01	0
Total participants	2015-10-01	0

Form 5500 Responses for OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN

2015: OLIVE AVENUE STAFFING HEALTH AND WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	First time form 5500 has been submitted	Yes
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

000010208090

Policy instance

Insurance contract or identification number	000010208090
Number of Individuals Covered	190
Insurance policy start date	2015-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $5,333
Total amount of fees paid to insurance company	USD $949
Are there contracts with allocated funds for individual policies?	No
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	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

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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