401k Plan data: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN plan

IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE 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

IPSWICH BAY GLASS COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: IPSWICH BAY GLASS COMPANY, INC.

Employer identification number (EIN): 042538458

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 BRIAN PATRICAN 2024-03-05
501 2022-01-01 BRIAN PATRICAN 2023-04-21
501 2021-01-01 BRIAN PATRICAN 2022-03-14
501 2020-01-01 BRIAN J. PATRICAN 2021-07-07
501 2019-01-01 BRIAN PATRICAN 2020-04-02
501 2018-01-01
501 2017-01-01
501 2016-01-01 BRIAN J. PATRICAN BRIAN J. PATRICAN 2017-04-06
501 2015-01-01 BRIAN J. PATRICAN BRIAN J. PATRICAN 2017-03-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	BRIAN PATRICAN	2024-03-05
501	2022-01-01	BRIAN PATRICAN	2023-04-21
501	2021-01-01	BRIAN PATRICAN	2022-03-14
501	2020-01-01	BRIAN J. PATRICAN	2021-07-07
501	2019-01-01	BRIAN PATRICAN	2020-04-02
501	2018-01-01
501	2017-01-01
501	2016-01-01	BRIAN J. PATRICAN		BRIAN J. PATRICAN	2017-04-06
501	2015-01-01	BRIAN J. PATRICAN		BRIAN J. PATRICAN	2017-03-28

Form 5500 Responses for IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN

2023: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE 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: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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
2015: IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45470000

Policy instance

Insurance contract or identification number	45470000
Number of Individuals Covered	17
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $869
Total amount of fees paid to insurance company	USD $675
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

396746

Policy instance

Insurance contract or identification number	396746
Number of Individuals Covered	125
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $6,232
Total amount of fees paid to insurance company	USD $2,685
Dental Insurance Welfare Benefit	Yes
Life 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 $128,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78012000

Policy instance

Insurance contract or identification number	78012000
Number of Individuals Covered	276
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $32,767
Total amount of fees paid to insurance company	USD $10,972
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,355,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78012000

Policy instance

Insurance contract or identification number	78012000
Number of Individuals Covered	292
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $23,313
Total amount of fees paid to insurance company	USD $10,972
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,458,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

396746

Policy instance

Insurance contract or identification number	396746
Number of Individuals Covered	129
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $7,099
Total amount of fees paid to insurance company	USD $5,154
Dental 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 $158,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45470000

Policy instance

Insurance contract or identification number	45470000
Number of Individuals Covered	18
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $1,176
Total amount of fees paid to insurance company	USD $675
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45470000

Policy instance

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

Policy contract number

396746

Policy instance

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78012000

Policy instance

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45470000

Policy instance

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

Policy contract number

396746

Policy instance

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78012000

Policy instance

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45470000

Policy instance

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

Policy contract number

396746

Policy instance

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78012000

Policy instance

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78012000

Policy instance

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

Policy contract number

396746

Policy instance

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45470000

Policy instance

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45470000

Policy instance

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

Policy contract number

396746

Policy instance

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78012000

Policy instance

Potentially related plans

IPSWICH BAY ADVISORS 401(K) PLAN [EIN = 043404959]

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Company Name:	IPSWICH BAY GLASS COMPANY, INC.
Employer identification number (EIN):	042538458
NAIC Classification:	238900