401k Plan data: LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE plan

LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE 401k Plan overview

Plan Name	LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE
Plan identification number	510

LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness)

401k Sponsoring company profile

LGS STAFFING has sponsored the creation of one or more 401k plans.

Company Name: LGS STAFFING

Employer identification number (EIN): 582428073

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2015-10-28 JERRY AINSWORTH 2022-06-10
510 2014-10-28 JERRY AINSWORTH 2022-06-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
510	2015-10-28	JERRY AINSWORTH	2022-06-10
510	2014-10-28	JERRY AINSWORTH	2022-06-10

Plan Statistics for LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE

401k plan membership statisitcs for LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE

Measure Date Value
2015: LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE 2015 401k membership
Total participants, beginning-of-year 2015-10-28 144
Total number of active participants reported on line 7a of the Form 5500 2015-10-28 42
Total of all active and inactive participants 2015-10-28 42
Total participants 2015-10-28 42
2014: LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE 2014 401k membership
Total participants, beginning-of-year 2014-10-28 61
Total number of active participants reported on line 7a of the Form 5500 2014-10-28 144
Total of all active and inactive participants 2014-10-28 144
Total participants 2014-10-28 144

Measure	Date	Value
2015: LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE 2015 401k membership
Total participants, beginning-of-year	2015-10-28	144
Total number of active participants reported on line 7a of the Form 5500	2015-10-28	42
Total of all active and inactive participants	2015-10-28	42
Total participants	2015-10-28	42
2014: LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE 2014 401k membership
Total participants, beginning-of-year	2014-10-28	61
Total number of active participants reported on line 7a of the Form 5500	2014-10-28	144
Total of all active and inactive participants	2014-10-28	144
Total participants	2014-10-28	144

Form 5500 Responses for LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE

2015: LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE 2015 form 5500 responses
2015-10-28	Type of plan entity	Single employer plan
2015-10-28	Submission has been amended	No
2015-10-28	This submission is the final filing	No
2015-10-28	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-28	Plan is a collectively bargained plan	No
2015-10-28	Plan funding arrangement – Insurance	Yes
2015-10-28	Plan funding arrangement – General assets of the sponsor	Yes
2015-10-28	Plan benefit arrangement – Insurance	Yes
2015-10-28	Plan benefit arrangement – General assets of the sponsor	Yes
2014: LABOR GUYS, L.L.C. ESSENTIAL STAFFCARE 2014 form 5500 responses
2014-10-28	Type of plan entity	Single employer plan
2014-10-28	Submission has been amended	No
2014-10-28	This submission is the final filing	No
2014-10-28	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-28	Plan is a collectively bargained plan	No
2014-10-28	Plan funding arrangement – Insurance	Yes
2014-10-28	Plan funding arrangement – General assets of the sponsor	Yes
2014-10-28	Plan benefit arrangement – Insurance	Yes
2014-10-28	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )

Policy contract number

PAI-M-276100

Policy instance

Insurance contract or identification number	PAI-M-276100
Number of Individuals Covered	42
Insurance policy start date	2015-10-28
Insurance policy end date	2016-10-27
Total amount of commissions paid to insurance broker	USD $11,088
Total amount of fees paid to insurance company	USD $12,685
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	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $87,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	12685
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATOR
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $11,088

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

PAI-L-276100

Policy instance

Insurance contract or identification number	PAI-L-276100
Number of Individuals Covered	26
Insurance policy start date	2015-10-28
Insurance policy end date	2016-10-27
Total amount of commissions paid to insurance broker	USD $815
Total amount of fees paid to insurance company	USD $739
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $5,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $815
Insurance broker organization code?	3
Amount paid for insurance broker fees	739
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATOR

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

PAI-L-276100

Policy instance

Insurance contract or identification number	PAI-L-276100
Number of Individuals Covered	144
Insurance policy start date	2014-10-28
Insurance policy end date	2015-10-27
Total amount of commissions paid to insurance broker	USD $1,048
Total amount of fees paid to insurance company	USD $606
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $4,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,048
Insurance broker organization code?	3
Amount paid for insurance broker fees	606
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATOR

BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )

Policy contract number

PAI-M-276100

Policy instance

Insurance contract or identification number	PAI-M-276100
Number of Individuals Covered	144
Insurance policy start date	2014-10-28
Insurance policy end date	2015-10-27
Total amount of commissions paid to insurance broker	USD $12,935
Total amount of fees paid to insurance company	USD $17,762
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	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $122,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	17762
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATOR
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $12,935

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Company Name:	LGS STAFFING
Employer identification number (EIN):	582428073
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations