401k Plan data: MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN plan

MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN 401k Plan overview

Plan Name	MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN
Plan identification number	511

MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

MISKELLY FURNITURE WAREHOUSE, INC. has sponsored the creation of one or more 401k plans.

Company Name: MISKELLY FURNITURE WAREHOUSE, INC.

Employer identification number (EIN): 640616673

NAIC Classification: 442110
NAIC Description: Furniture Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
511 2017-09-01
511 2017-09-01

Plan Statistics for MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN

401k plan membership statisitcs for MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN

Measure Date Value
2017: MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-09-01 119
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 119
Number of retired or separated participants receiving benefits 2017-09-01 0
Number of other retired or separated participants entitled to future benefits 2017-09-01 0
Total of all active and inactive participants 2017-09-01 119

Measure	Date	Value
2017: MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	119
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	119
Number of retired or separated participants receiving benefits	2017-09-01	0
Number of other retired or separated participants entitled to future benefits	2017-09-01	0
Total of all active and inactive participants	2017-09-01	119

Form 5500 Responses for MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN

2017: MISKELLY FURNITURE WAREHOUSE, INC DENTAL PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	First time form 5500 has been submitted	Yes
2017-09-01	Submission has been amended	No
2017-09-01	This submission is the final filing	No
2017-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-09-01	Plan is a collectively bargained plan	No
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

D4384

Policy instance

Insurance contract or identification number	D4384
Number of Individuals Covered	119
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $6,617
Total amount of fees paid to insurance company	USD $8,272
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $66,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MISKELLY FURNITURE WAREHOUSE, INC.
Employer identification number (EIN):	640616673
NAIC Classification:	442110
NAIC Description:	Furniture Stores