401k Plan data: ACCIDENTIAL DEATH AND DISMEMBERMENT plan

ACCIDENTIAL DEATH AND DISMEMBERMENT 401k Plan overview

Plan Name	ACCIDENTIAL DEATH AND DISMEMBERMENT
Plan identification number	506

ACCIDENTIAL DEATH AND DISMEMBERMENT Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

AMERICAN BROADBAND HOLDING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN BROADBAND HOLDING COMPANY

Employer identification number (EIN): 208862855

NAIC Classification: 517000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ACCIDENTIAL DEATH AND DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2021-01-01
506 2021-01-01 CRISTINA MARTINEZ 2023-09-18
506 2020-01-01
506 2019-01-01

Plan Statistics for ACCIDENTIAL DEATH AND DISMEMBERMENT

401k plan membership statisitcs for ACCIDENTIAL DEATH AND DISMEMBERMENT

Measure Date Value
2021: ACCIDENTIAL DEATH AND DISMEMBERMENT 2021 401k membership
Total participants, beginning-of-year 2021-01-01 76
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 79
Total of all active and inactive participants 2021-01-01 79
Total participants 2021-01-01 79
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Number of employers contributing to the scheme 2021-01-01 0
2020: ACCIDENTIAL DEATH AND DISMEMBERMENT 2020 401k membership
Total participants, beginning-of-year 2020-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 76
Total of all active and inactive participants 2020-01-01 76
Total participants 2020-01-01 76
2019: ACCIDENTIAL DEATH AND DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year 2019-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 78
Total of all active and inactive participants 2019-01-01 78
Total participants 2019-01-01 78

Measure	Date	Value
2021: ACCIDENTIAL DEATH AND DISMEMBERMENT 2021 401k membership
Total participants, beginning-of-year	2021-01-01	76
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	79
Total of all active and inactive participants	2021-01-01	79
Total participants	2021-01-01	79
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Number of employers contributing to the scheme	2021-01-01	0
2020: ACCIDENTIAL DEATH AND DISMEMBERMENT 2020 401k membership
Total participants, beginning-of-year	2020-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	76
Total of all active and inactive participants	2020-01-01	76
Total participants	2020-01-01	76
2019: ACCIDENTIAL DEATH AND DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year	2019-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	78
Total of all active and inactive participants	2019-01-01	78
Total participants	2019-01-01	78

Form 5500 Responses for ACCIDENTIAL DEATH AND DISMEMBERMENT

2021: ACCIDENTIAL DEATH AND DISMEMBERMENT 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	This submission is the final filing	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ACCIDENTIAL DEATH AND DISMEMBERMENT 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: ACCIDENTIAL DEATH AND DISMEMBERMENT 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

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BH7H

Policy instance

Insurance contract or identification number	G000BH7H
Number of Individuals Covered	79
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,208
Other welfare benefits provided	ACCIDENT DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $41,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,156
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Total amount of fees paid to insurance company	USD $0
Amount paid for insurance broker fees	0

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BH7H

Policy instance

Insurance contract or identification number	G000BH7H
Number of Individuals Covered	76
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,615
Other welfare benefits provided	ACCIDENT DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $43,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,461
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BH7H

Policy instance

Insurance contract or identification number	G000BH7H
Number of Individuals Covered	78
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,131
Other welfare benefits provided	ACCIDENT DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $40,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,098
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES

Potentially related plans

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Company Name:	AMERICAN BROADBAND HOLDING COMPANY
Employer identification number (EIN):	208862855
NAIC Classification:	517000

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
506	2021-01-01
506	2021-01-01	CRISTINA MARTINEZ	2023-09-18
506	2020-01-01
506	2019-01-01