401k Plan data: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN plan

UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN
Plan identification number	501

UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 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

UPRIVER, LLC has sponsored the creation of one or more 401k plans.

Company Name: UPRIVER, LLC

Employer identification number (EIN): 911706611

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

Additional information about UPRIVER, LLC

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1998-09-10

Company Identification Number: 601900438

Legal Registered Office Address: 2510 N PINES RD STE 1

SPOKANE VALLEY
United States of America (USA)
992067636

More information about UPRIVER, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-12-01 ISABEL DREHER
501 2016-12-01 ISABEL DREHER
501 2015-12-01 RJ MEYER
501 2014-12-01 RANDY J MEYER
501 2013-12-01 RJ MEYER
501 2012-12-01 RANDY MEYER
501 2011-12-01 RANDY MEYER
501 2010-12-01 RANDY MEYER
501 2009-12-01 RANDY MEYER

Plan id#	Filing Submission Date	Name of Administrator
501	2017-12-01	ISABEL DREHER
501	2016-12-01	ISABEL DREHER
501	2015-12-01	RJ MEYER
501	2014-12-01	RANDY J MEYER
501	2013-12-01	RJ MEYER
501	2012-12-01	RANDY MEYER
501	2011-12-01	RANDY MEYER
501	2010-12-01	RANDY MEYER
501	2009-12-01	RANDY MEYER

Plan Statistics for UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN

401k plan membership statisitcs for UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN

Measure Date Value
2017: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-12-01 263
Total number of active participants reported on line 7a of the Form 5500 2017-12-01 284
Total of all active and inactive participants 2017-12-01 284
Total participants 2017-12-01 284
2016: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-12-01 253
Total number of active participants reported on line 7a of the Form 5500 2016-12-01 263
Total of all active and inactive participants 2016-12-01 263
Total participants 2016-12-01 263
2015: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-12-01 253
Total number of active participants reported on line 7a of the Form 5500 2015-12-01 264
Number of retired or separated participants receiving benefits 2015-12-01 0
Number of other retired or separated participants entitled to future benefits 2015-12-01 0
Total of all active and inactive participants 2015-12-01 264
2014: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-12-01 204
Total number of active participants reported on line 7a of the Form 5500 2014-12-01 253
Number of retired or separated participants receiving benefits 2014-12-01 0
Number of other retired or separated participants entitled to future benefits 2014-12-01 0
Total of all active and inactive participants 2014-12-01 253
2013: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-12-01 201
Total number of active participants reported on line 7a of the Form 5500 2013-12-01 204
Number of retired or separated participants receiving benefits 2013-12-01 0
Number of other retired or separated participants entitled to future benefits 2013-12-01 0
Total of all active and inactive participants 2013-12-01 204
2012: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-12-01 252
Total number of active participants reported on line 7a of the Form 5500 2012-12-01 201
Number of retired or separated participants receiving benefits 2012-12-01 0
Number of other retired or separated participants entitled to future benefits 2012-12-01 0
Total of all active and inactive participants 2012-12-01 201
2011: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-12-01 368
Total number of active participants reported on line 7a of the Form 5500 2011-12-01 252
Number of retired or separated participants receiving benefits 2011-12-01 0
Number of other retired or separated participants entitled to future benefits 2011-12-01 0
Total of all active and inactive participants 2011-12-01 252
2010: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-12-01 122
Total number of active participants reported on line 7a of the Form 5500 2010-12-01 169
Number of retired or separated participants receiving benefits 2010-12-01 0
Number of other retired or separated participants entitled to future benefits 2010-12-01 0
Total of all active and inactive participants 2010-12-01 169
2009: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-12-01 122
Total number of active participants reported on line 7a of the Form 5500 2009-12-01 122
Number of retired or separated participants receiving benefits 2009-12-01 0
Number of other retired or separated participants entitled to future benefits 2009-12-01 0
Total of all active and inactive participants 2009-12-01 122

Measure	Date	Value
2017: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-12-01	263
Total number of active participants reported on line 7a of the Form 5500	2017-12-01	284
Total of all active and inactive participants	2017-12-01	284
Total participants	2017-12-01	284
2016: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-12-01	253
Total number of active participants reported on line 7a of the Form 5500	2016-12-01	263
Total of all active and inactive participants	2016-12-01	263
Total participants	2016-12-01	263
2015: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-12-01	253
Total number of active participants reported on line 7a of the Form 5500	2015-12-01	264
Number of retired or separated participants receiving benefits	2015-12-01	0
Number of other retired or separated participants entitled to future benefits	2015-12-01	0
Total of all active and inactive participants	2015-12-01	264
2014: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-12-01	204
Total number of active participants reported on line 7a of the Form 5500	2014-12-01	253
Number of retired or separated participants receiving benefits	2014-12-01	0
Number of other retired or separated participants entitled to future benefits	2014-12-01	0
Total of all active and inactive participants	2014-12-01	253
2013: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-12-01	201
Total number of active participants reported on line 7a of the Form 5500	2013-12-01	204
Number of retired or separated participants receiving benefits	2013-12-01	0
Number of other retired or separated participants entitled to future benefits	2013-12-01	0
Total of all active and inactive participants	2013-12-01	204
2012: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-12-01	252
Total number of active participants reported on line 7a of the Form 5500	2012-12-01	201
Number of retired or separated participants receiving benefits	2012-12-01	0
Number of other retired or separated participants entitled to future benefits	2012-12-01	0
Total of all active and inactive participants	2012-12-01	201
2011: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-12-01	368
Total number of active participants reported on line 7a of the Form 5500	2011-12-01	252
Number of retired or separated participants receiving benefits	2011-12-01	0
Number of other retired or separated participants entitled to future benefits	2011-12-01	0
Total of all active and inactive participants	2011-12-01	252
2010: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-12-01	122
Total number of active participants reported on line 7a of the Form 5500	2010-12-01	169
Number of retired or separated participants receiving benefits	2010-12-01	0
Number of other retired or separated participants entitled to future benefits	2010-12-01	0
Total of all active and inactive participants	2010-12-01	169
2009: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-12-01	122
Total number of active participants reported on line 7a of the Form 5500	2009-12-01	122
Number of retired or separated participants receiving benefits	2009-12-01	0
Number of other retired or separated participants entitled to future benefits	2009-12-01	0
Total of all active and inactive participants	2009-12-01	122

Form 5500 Responses for UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN

2017: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-12-01	Type of plan entity	Single employer plan
2017-12-01	Submission has been amended	No
2017-12-01	This submission is the final filing	No
2017-12-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-12-01	Plan is a collectively bargained plan	No
2017-12-01	Plan funding arrangement – Insurance	Yes
2017-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-12-01	Plan benefit arrangement – Insurance	Yes
2017-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-12-01	Type of plan entity	Single employer plan
2016-12-01	Submission has been amended	No
2016-12-01	This submission is the final filing	No
2016-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-12-01	Plan is a collectively bargained plan	No
2016-12-01	Plan funding arrangement – Insurance	Yes
2016-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-12-01	Plan benefit arrangement – Insurance	Yes
2016-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	Submission has been amended	No
2015-12-01	This submission is the final filing	No
2015-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-12-01	Plan is a collectively bargained plan	No
2015-12-01	Plan funding arrangement – Insurance	Yes
2015-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-12-01	Plan benefit arrangement – Insurance	Yes
2015-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-12-01	Type of plan entity	Single employer plan
2014-12-01	Submission has been amended	No
2014-12-01	This submission is the final filing	No
2014-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-12-01	Plan is a collectively bargained plan	No
2014-12-01	Plan funding arrangement – Insurance	Yes
2014-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-12-01	Plan benefit arrangement – Insurance	Yes
2014-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-12-01	Type of plan entity	Single employer plan
2013-12-01	Submission has been amended	No
2013-12-01	This submission is the final filing	No
2013-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-12-01	Plan is a collectively bargained plan	No
2013-12-01	Plan funding arrangement – Insurance	Yes
2013-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-12-01	Plan benefit arrangement – Insurance	Yes
2013-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Submission has been amended	No
2012-12-01	This submission is the final filing	No
2012-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-12-01	Plan is a collectively bargained plan	No
2012-12-01	Plan funding arrangement – Insurance	Yes
2012-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-12-01	Plan benefit arrangement – Insurance	Yes
2012-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-12-01	Type of plan entity	Single employer plan
2011-12-01	Submission has been amended	No
2011-12-01	This submission is the final filing	No
2011-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-12-01	Plan is a collectively bargained plan	No
2011-12-01	Plan funding arrangement – Insurance	Yes
2011-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-12-01	Plan benefit arrangement – Insurance	Yes
2011-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2010 form 5500 responses
2010-12-01	Type of plan entity	Single employer plan
2010-12-01	Submission has been amended	No
2010-12-01	This submission is the final filing	No
2010-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-12-01	Plan is a collectively bargained plan	No
2010-12-01	Plan funding arrangement – Insurance	Yes
2010-12-01	Plan benefit arrangement – Insurance	Yes
2009: UPRIVER, LLC GROUP HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-12-01	Type of plan entity	Single employer plan
2009-12-01	Submission has been amended	No
2009-12-01	This submission is the final filing	No
2009-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-12-01	Plan is a collectively bargained plan	No
2009-12-01	Plan funding arrangement – Insurance	Yes
2009-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00607298

Policy instance

Insurance contract or identification number	00607298
Number of Individuals Covered	284
Insurance policy start date	2017-12-01
Insurance policy end date	2017-12-31
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $47,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,770
Amount paid for insurance broker fees	1804
Additional information about fees paid to insurance broker	INCENTIVE PAYMENTS
Insurance broker organization code?	3
Insurance broker name	KIBBLE AND PRENTICE HOLDING COMPANY

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00473207

Policy instance

Insurance contract or identification number	00473207
Number of Individuals Covered	299
Insurance policy start date	2017-12-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $867
Total amount of fees paid to insurance company	USD $0
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 $2,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $867
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	KIBBLE AND PRENTICE HOLDING COMPANY

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Company Name:	UPRIVER, LLC
Employer identification number (EIN):	911706611
NAIC Classification:	721110
NAIC Description:	Hotels (except Casino Hotels) and Motels

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1998-09-10
Company Identification Number:	601900438
Legal Registered Office Address:	2510 N PINES RD STE 1 SPOKANE VALLEY United States of America (USA) 992067636