401k Plan data: EMPLOYER LGA WELFARE BENEFIT PLAN plan

EMPLOYER LGA WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	EMPLOYER LGA WELFARE BENEFIT PLAN
Plan identification number	501

EMPLOYER LGA WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover

401k Sponsoring company profile

EMPOWER LGA, INC. has sponsored the creation of one or more 401k plans.

Company Name: EMPOWER LGA, INC.

Employer identification number (EIN): 042734184

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYER LGA WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01

Plan Statistics for EMPLOYER LGA WELFARE BENEFIT PLAN

401k plan membership statisitcs for EMPLOYER LGA WELFARE BENEFIT PLAN

Measure Date Value
2022: EMPLOYER LGA WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 117
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 117
Total of all active and inactive participants 2022-07-01 117

Measure	Date	Value
2022: EMPLOYER LGA WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	117
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	117
Total of all active and inactive participants	2022-07-01	117

Form 5500 Responses for EMPLOYER LGA WELFARE BENEFIT PLAN

2022: EMPLOYER LGA WELFARE 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	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

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

Policy contract number

02Q5058

Policy instance

Insurance contract or identification number	02Q5058
Number of Individuals Covered	102
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $21,743
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $724,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,743

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

013277

Policy instance

Insurance contract or identification number	013277
Number of Individuals Covered	117
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,563
Total amount of fees paid to insurance company	USD $1,269
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,563
Amount paid for insurance broker fees	1269

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

013277

Policy instance

Insurance contract or identification number	013277
Number of Individuals Covered	117
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,566
Total amount of fees paid to insurance company	USD $746
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,566
Amount paid for insurance broker fees	746

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4960436

Policy instance

Insurance contract or identification number	4960436
Number of Individuals Covered	68
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,922
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,922

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10069631001

Policy instance

Insurance contract or identification number	10069631001
Number of Individuals Covered	53
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $363
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $363

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	EMPOWER LGA, INC.
Employer identification number (EIN):	042734184
NAIC Classification:	624100
NAIC Description:	Individual and Family Services