401k Plan data: BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN plan

BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN
Plan identification number	501

BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BROADWAY SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: BROADWAY SERVICES, INC.

Employer identification number (EIN): 731665555

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about BROADWAY SERVICES, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1988-05-13

Company Identification Number: K23538

Legal Registered Office Address: 1230 STARDUST

NORTH LAUDERDALE

33068

More information about BROADWAY SERVICES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-11-01 LYNN SWETLAND LYNN SWETLAND 2016-04-15
501 2014-03-01 LYNN SWETLAND LYNN SWETLAND 2015-09-30
501 2014-03-01 LYNN SWETLAND

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2014-11-01	LYNN SWETLAND	LYNN SWETLAND	2016-04-15
501	2014-03-01	LYNN SWETLAND	LYNN SWETLAND	2015-09-30
501	2014-03-01	LYNN SWETLAND

Plan Statistics for BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN

401k plan membership statisitcs for BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN

Measure Date Value
2014: BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-11-01 125
Total number of active participants reported on line 7a of the Form 5500 2014-11-01 147
Total of all active and inactive participants 2014-11-01 147
Total participants 2014-11-01 147
Total participants, beginning-of-year 2014-03-01 111
Total number of active participants reported on line 7a of the Form 5500 2014-03-01 111
Number of retired or separated participants receiving benefits 2014-03-01 1
Number of other retired or separated participants entitled to future benefits 2014-03-01 0
Total of all active and inactive participants 2014-03-01 112
Total participants 2014-03-01 112

Measure	Date	Value
2014: BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-11-01	125
Total number of active participants reported on line 7a of the Form 5500	2014-11-01	147
Total of all active and inactive participants	2014-11-01	147
Total participants	2014-11-01	147
Total participants, beginning-of-year	2014-03-01	111
Total number of active participants reported on line 7a of the Form 5500	2014-03-01	111
Number of retired or separated participants receiving benefits	2014-03-01	1
Number of other retired or separated participants entitled to future benefits	2014-03-01	0
Total of all active and inactive participants	2014-03-01	112
Total participants	2014-03-01	112

Form 5500 Responses for BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN

2014: BROADWAY SERVICES, INC.-WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-11-01	Type of plan entity	Single employer plan
2014-11-01	First time form 5500 has been submitted	Yes
2014-11-01	Plan funding arrangement – Insurance	Yes
2014-11-01	Plan benefit arrangement – Insurance	Yes
2014-03-01	Type of plan entity	Single employer plan
2014-03-01	First time form 5500 has been submitted	Yes
2014-03-01	Submission has been amended	Yes
2014-03-01	This submission is the final filing	No
2014-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-03-01	Plan is a collectively bargained plan	No
2014-03-01	Plan funding arrangement – Insurance	Yes
2014-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FG1D1362

Policy instance

Insurance contract or identification number	FG1D1362
Number of Individuals Covered	135
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $9,408
Total amount of fees paid to insurance company	USD $122
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $105,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,408
Amount paid for insurance broker fees	122
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BELLINGRATH WEALTH MGMT

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

7833ERC

Policy instance

Insurance contract or identification number	7833ERC
Number of Individuals Covered	112
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $33,260
Total amount of fees paid to insurance company	USD $11,780
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $665,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
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
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
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 $33,260
Amount paid for insurance broker fees	11780
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	RORY RONIGER

Potentially related plans

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Company Name:	BROADWAY SERVICES, INC.
Employer identification number (EIN):	731665555
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1988-05-13
Company Identification Number:	K23538
Legal Registered Office Address:	1230 STARDUST NORTH LAUDERDALE 33068