401k Plan data: THE GRANITE YMCA EMPLOYEE BENEFIT PLAN plan

THE GRANITE YMCA EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	THE GRANITE YMCA EMPLOYEE BENEFIT PLAN
Plan identification number	503

THE GRANITE YMCA EMPLOYEE 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 Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

YMCA OF GREATER MANCHESTER has sponsored the creation of one or more 401k plans.

Company Name: YMCA OF GREATER MANCHESTER

Employer identification number (EIN): 020222248

NAIC Classification: 713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE GRANITE YMCA EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-07-01 JACKIE WOZNIAK 2023-11-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2022-07-01	JACKIE WOZNIAK	2023-11-08

Plan Statistics for THE GRANITE YMCA EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for THE GRANITE YMCA EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: THE GRANITE YMCA EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 181
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 0
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 0
Number of employers contributing to the scheme 2022-07-01 0

Measure	Date	Value
2022: THE GRANITE YMCA EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	181
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	0
Number of retired or separated participants receiving benefits	2022-07-01	0
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	0
Number of employers contributing to the scheme	2022-07-01	0

Form 5500 Responses for THE GRANITE YMCA EMPLOYEE BENEFIT PLAN

2022: THE GRANITE YMCA EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	First time form 5500 has been submitted	Yes
2022-07-01	This submission is the final filing	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

575243

Policy instance

Insurance contract or identification number	575243
Number of Individuals Covered	179
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $13,917
Total amount of fees paid to insurance company	USD $3,182
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 $90,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,480
Amount paid for insurance broker fees	3182
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )

Policy contract number

1640

Policy instance

Insurance contract or identification number	1640
Number of Individuals Covered	118
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $4,651
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,114
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4150728

Policy instance

Insurance contract or identification number	E4150728
Number of Individuals Covered	17
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $818
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $14,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $300
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 )

Policy contract number

0750310000

Policy instance

Insurance contract or identification number	0750310000
Number of Individuals Covered	90
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $21,607
Total amount of fees paid to insurance company	USD $0
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
Welfare Benefit Premiums Paid to Carrier	USD $543,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $16,518
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

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Company Name:	YMCA OF GREATER MANCHESTER
Employer identification number (EIN):	020222248
NAIC Classification:	713900