401k Plan data: FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN plan

FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN 401k Plan overview

Plan Name	FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN
Plan identification number	501

FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN 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) 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

FOUNTAINHEAD DEVELOPMENT, INC. has sponsored the creation of one or more 401k plans.

Company Name: FOUNTAINHEAD DEVELOPMENT, INC.

Employer identification number (EIN): 920112296

NAIC Classification: 531390
NAIC Description: Other Activities Related to Real Estate

Additional information about FOUNTAINHEAD DEVELOPMENT, INC.

Jurisdiction of Incorporation: Alaska Department Commerce, Community & Economic Development

Incorporation Date: 1985-10-21

Company Identification Number: 36844D

Legal Registered Office Address: 1501 QUEENS WY

FAIRBANKS
United States of America (USA)
99701

More information about FOUNTAINHEAD DEVELOPMENT, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01
501 2016-01-01 KATIE LANNING

Plan Statistics for FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN

401k plan membership statisitcs for FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN

Measure Date Value
2017: FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 91
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 91
2016: FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 109
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 109

Measure	Date	Value
2017: FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	91
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	91
2016: FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	109
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	109

Form 5500 Responses for FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN

2017: FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: FOUNTAINHEAD DEVELOPMENT, INC. HEALTH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47201 )

Policy contract number

30064722

Policy instance

Insurance contract or identification number	30064722
Number of Individuals Covered	86
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $715
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $715
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

PREMERA BLUE CROSS BLUE SHIELD OF ALASKA, INC. (National Association of Insurance Commissioners NAIC id number: 11677 )

Policy contract number

1008335

Policy instance

Insurance contract or identification number	1008335
Number of Individuals Covered	74
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $49,538
Total amount of fees paid to insurance company	USD $5,082
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $942,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,538
Amount paid for insurance broker fees	5082
Additional information about fees paid to insurance broker	PREFERRED PRODUCER PROGRAM
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

951893

Policy instance

Insurance contract or identification number	951893
Number of Individuals Covered	37
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,756
Total amount of fees paid to insurance company	USD $768
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $38,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,756
Amount paid for insurance broker fees	768
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

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Company Name:	FOUNTAINHEAD DEVELOPMENT, INC.
Employer identification number (EIN):	920112296
NAIC Classification:	531390
NAIC Description:	Other Activities Related to Real Estate

Jurisdiction of Incorporation:	Alaska Department Commerce, Community & Economic Development
Incorporation Date:	1985-10-21
Company Identification Number:	36844D
Legal Registered Office Address:	1501 QUEENS WY FAIRBANKS United States of America (USA) 99701