401k Plan data: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION plan

PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 401k Plan overview

Plan Name	PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION
Plan identification number	501

PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PAH MANAGEMENT has sponsored the creation of one or more 401k plans.

Company Name: PAH MANAGEMENT

Employer identification number (EIN): 813508961

NAIC Classification: 721110
NAIC Description: Hotels (except Casino Hotels) and Motels

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-03-01 KELLI JOSEPH 2020-09-30
501 2018-03-01 JAY ANDERSON 2019-12-03
501 2017-03-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2019-03-01	KELLI JOSEPH	2020-09-30
501	2018-03-01	JAY ANDERSON	2019-12-03
501	2017-03-01

Plan Statistics for PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION

401k plan membership statisitcs for PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION

Measure Date Value
2019: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2019 401k membership
Total participants, beginning-of-year 2019-03-01 353
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 125
Number of retired or separated participants receiving benefits 2019-03-01 0
Number of other retired or separated participants entitled to future benefits 2019-03-01 0
Total of all active and inactive participants 2019-03-01 125
Number of employers contributing to the scheme 2019-03-01 0
2018: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2018 401k membership
Total participants, beginning-of-year 2018-03-01 249
Total number of active participants reported on line 7a of the Form 5500 2018-03-01 645
Number of retired or separated participants receiving benefits 2018-03-01 3
Number of other retired or separated participants entitled to future benefits 2018-03-01 0
Total of all active and inactive participants 2018-03-01 648
Number of employers contributing to the scheme 2018-03-01 0
2017: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2017 401k membership
Total participants, beginning-of-year 2017-03-01 100
Total number of active participants reported on line 7a of the Form 5500 2017-03-01 91
Number of retired or separated participants receiving benefits 2017-03-01 0
Number of other retired or separated participants entitled to future benefits 2017-03-01 0
Total of all active and inactive participants 2017-03-01 91

Measure	Date	Value
2019: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2019 401k membership
Total participants, beginning-of-year	2019-03-01	353
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	125
Number of retired or separated participants receiving benefits	2019-03-01	0
Number of other retired or separated participants entitled to future benefits	2019-03-01	0
Total of all active and inactive participants	2019-03-01	125
Number of employers contributing to the scheme	2019-03-01	0
2018: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2018 401k membership
Total participants, beginning-of-year	2018-03-01	249
Total number of active participants reported on line 7a of the Form 5500	2018-03-01	645
Number of retired or separated participants receiving benefits	2018-03-01	3
Number of other retired or separated participants entitled to future benefits	2018-03-01	0
Total of all active and inactive participants	2018-03-01	648
Number of employers contributing to the scheme	2018-03-01	0
2017: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2017 401k membership
Total participants, beginning-of-year	2017-03-01	100
Total number of active participants reported on line 7a of the Form 5500	2017-03-01	91
Number of retired or separated participants receiving benefits	2017-03-01	0
Number of other retired or separated participants entitled to future benefits	2017-03-01	0
Total of all active and inactive participants	2017-03-01	91

Form 5500 Responses for PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION

2019: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes
2018: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2018 form 5500 responses
2018-03-01	Type of plan entity	Single employer plan
2018-03-01	Plan funding arrangement – Insurance	Yes
2018-03-01	Plan benefit arrangement – Insurance	Yes
2017: PAH MANAGEMENT WELFARE BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION 2017 form 5500 responses
2017-03-01	Type of plan entity	Single employer plan
2017-03-01	First time form 5500 has been submitted	Yes
2017-03-01	Plan funding arrangement – Insurance	Yes
2017-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

911083

Policy instance

Insurance contract or identification number	911083
Number of Individuals Covered	125
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $31,715
Total amount of fees paid to insurance company	USD $63,171
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $1,188,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,179
Amount paid for insurance broker fees	60755
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

911083

Policy instance

Insurance contract or identification number	911083
Number of Individuals Covered	645
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $26,707
Total amount of fees paid to insurance company	USD $62,366
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $1,511,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,707
Amount paid for insurance broker fees	62366
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT BONUS
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

911083

Policy instance

Insurance contract or identification number	911083
Number of Individuals Covered	215
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $5,547
Total amount of fees paid to insurance company	USD $39,503
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision 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	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $899,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,547
Amount paid for insurance broker fees	39503
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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Company Name:	PAH MANAGEMENT
Employer identification number (EIN):	813508961
NAIC Classification:	721110
NAIC Description:	Hotels (except Casino Hotels) and Motels