401k Plan data: K&M CASINOS, INC plan

K&M CASINOS, INC 401k Plan overview

Plan Name	K&M CASINOS, INC
Plan identification number	501

K&M CASINOS, INC Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

K&M CASINOS INC has sponsored the creation of one or more 401k plans.

Company Name: K&M CASINOS INC

Employer identification number (EIN): 822783063

NAIC Classification: 713100
NAIC Description: Amusement Parks and Arcades

Form 5500 Filing Information

Submission information for form 5500 for 401k plan K&M CASINOS, INC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-03-01 MANNY PEREZ 2020-03-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-03-01	MANNY PEREZ	2020-03-13

Plan Statistics for K&M CASINOS, INC

401k plan membership statisitcs for K&M CASINOS, INC

Measure Date Value
2019: K&M CASINOS, INC 2019 401k membership
Total participants, beginning-of-year 2019-03-01 237
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 225
Number of retired or separated participants receiving benefits 2019-03-01 1
Number of other retired or separated participants entitled to future benefits 2019-03-01 0
Total of all active and inactive participants 2019-03-01 226
Number of employers contributing to the scheme 2019-03-01 0

Measure	Date	Value
2019: K&M CASINOS, INC 2019 401k membership
Total participants, beginning-of-year	2019-03-01	237
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	225
Number of retired or separated participants receiving benefits	2019-03-01	1
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	226
Number of employers contributing to the scheme	2019-03-01	0

Form 5500 Responses for K&M CASINOS, INC

2019: K&M CASINOS, INC 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	First time form 5500 has been submitted	Yes
2019-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14133

Policy instance

Insurance contract or identification number	14133
Number of Individuals Covered	52
Insurance policy start date	2019-03-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $212
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $127
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

34372

Policy instance

Insurance contract or identification number	34372
Number of Individuals Covered	32
Insurance policy start date	2019-03-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $54
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $54
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AMFIRST INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60250 )

Policy contract number

17645

Policy instance

Insurance contract or identification number	17645
Number of Individuals Covered	225
Insurance policy start date	2019-03-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $1,820
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $700
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

2X2269

Policy instance

Insurance contract or identification number	2X2269
Number of Individuals Covered	44
Insurance policy start date	2019-03-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $2,757
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,379
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AYYH

Policy instance

Insurance contract or identification number	GLUG0AYYH
Number of Individuals Covered	156
Insurance policy start date	2019-03-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $746
Total amount of fees paid to insurance company	USD $205
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	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $402
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OTHER COMPENSATION

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Company Name:	K&M CASINOS INC
Employer identification number (EIN):	822783063
NAIC Classification:	713100
NAIC Description:	Amusement Parks and Arcades