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| Plan Name | BILLIARDS OF TULSA DBA GALAXY HOME RECREATION BILLIARDS OF TULSA WRAP PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BILLIARDS OF TULSA INC |
| Employer identification number (EIN): | 731008954 |
| NAIC Classification: | 812990 |
| NAIC Description: | All Other Personal Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-07-01 | ZENA SHAH | 2024-03-14 |
| Measure | Date | Value |
|---|---|---|
| 2022: BILLIARDS OF TULSA DBA GALAXY HOME RECREATION BILLIARDS OF TULSA WRAP PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-07-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 99 |
| Number of retired or separated participants receiving benefits | 2022-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
| Total of all active and inactive participants | 2022-07-01 | 99 |
| Number of employers contributing to the scheme | 2022-07-01 | 0 |
| 2022: BILLIARDS OF TULSA DBA GALAXY HOME RECREATION BILLIARDS OF TULSA WRAP PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | First time form 5500 has been submitted | Yes |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) | |||||||||||||||||||||||||||||||||||
| Policy contract number | 12967 | ||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||
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| SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 ) | |||||||||||||||||||||||||||||||||||
| Policy contract number | 60195 | ||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||||||||||||||
| Policy contract number | 1159961 | ||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||
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| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |||||||||||||||||||||||||||||||||||
| Policy contract number | 169252 | ||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||
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