401k Plan data: SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN plan

SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN
Plan identification number	501

SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

SEATTLE SOCCER LLC has sponsored the creation of one or more 401k plans.

Company Name: SEATTLE SOCCER LLC

Employer identification number (EIN): 262503037

NAIC Classification: 711210
NAIC Description: Spectator Sports

Additional information about SEATTLE SOCCER LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4443671

More information about SEATTLE SOCCER LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 JENNIFER JORGENSEN 2024-07-24
501 2022-01-01 RILEY MUELLER 2023-08-23
501 2021-01-01 RILEY MUELLER 2022-07-19
501 2020-01-01 RILEY MUELLER 2021-06-11
501 2019-11-01 RILEY MUELLER 2020-07-14
501 2018-11-01 RILEY MUELLER 2020-04-07
501 2017-11-01 THOMAS RILEY 2019-05-14
501 2016-11-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	JENNIFER JORGENSEN	2024-07-24
501	2022-01-01	RILEY MUELLER	2023-08-23
501	2021-01-01	RILEY MUELLER	2022-07-19
501	2020-01-01	RILEY MUELLER	2021-06-11
501	2019-11-01	RILEY MUELLER	2020-07-14
501	2018-11-01	RILEY MUELLER	2020-04-07
501	2017-11-01	THOMAS RILEY	2019-05-14
501	2016-11-01

Form 5500 Responses for SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN

2023: SEATTLE SOUNDERS FC WELFARE BENEFITS 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 funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: SEATTLE SOUNDERS FC WELFARE BENEFITS 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: SEATTLE SOUNDERS FC WELFARE BENEFITS 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 funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: SEATTLE SOUNDERS FC WELFARE BENEFITS 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 funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-11-01	Type of plan entity	Single employer plan
2019-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-11-01	Plan funding arrangement – Insurance	Yes
2019-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-11-01	Plan benefit arrangement – Insurance	Yes
2019-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-11-01	Type of plan entity	Single employer plan
2018-11-01	Plan funding arrangement – Insurance	Yes
2018-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-11-01	Plan benefit arrangement – Insurance	Yes
2018-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-11-01	Type of plan entity	Single employer plan
2017-11-01	Plan funding arrangement – Insurance	Yes
2017-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-11-01	Plan benefit arrangement – Insurance	Yes
2017-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: SEATTLE SOUNDERS FC WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-11-01	Type of plan entity	Single employer plan
2016-11-01	First time form 5500 has been submitted	Yes
2016-11-01	Plan funding arrangement – Insurance	Yes
2016-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-11-01	Plan benefit arrangement – Insurance	Yes
2016-11-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	150
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

3952

Policy instance

Insurance contract or identification number	3952
Number of Individuals Covered	249
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $16,156
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

608392

Policy instance

Insurance contract or identification number	608392
Number of Individuals Covered	149
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $7,452
Total amount of fees paid to insurance company	USD $931
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 $74,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012601

Policy instance

Insurance contract or identification number	4012601
Number of Individuals Covered	98
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $95,749
Total amount of fees paid to insurance company	USD $15,286
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,915,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30055977

Policy instance

Insurance contract or identification number	30055977
Number of Individuals Covered	144
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $928
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	95
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30055977

Policy instance

Insurance contract or identification number	30055977
Number of Individuals Covered	135
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $851
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012601

Policy instance

Insurance contract or identification number	4012601
Number of Individuals Covered	242
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $88,034
Total amount of fees paid to insurance company	USD $13,336
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,760,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

608392

Policy instance

Insurance contract or identification number	608392
Number of Individuals Covered	135
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,279
Total amount of fees paid to insurance company	USD $785
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 $62,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

3952

Policy instance

Insurance contract or identification number	3952
Number of Individuals Covered	243
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,748
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

3952

Policy instance

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

Policy contract number

608392

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012601

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30055977

Policy instance

WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

3952

Policy instance

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

Policy contract number

608392

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012601

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30055977

Policy instance

WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30055977

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012601

Policy instance

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

Policy contract number

608392

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

3952

Policy instance

WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

3952

Policy instance

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

Policy contract number

608392

Policy instance

WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30055977

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012601

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30055977

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012601

Policy instance

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

Policy contract number

608392

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

3952

Policy instance

WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

EAP

Policy instance

Potentially related plans

SEATTLE SOUNDERS FC 401(K) PLAN [EIN = 262603037]

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Company Name:	SEATTLE SOCCER LLC
Employer identification number (EIN):	262503037
NAIC Classification:	711210
NAIC Description:	Spectator Sports

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4443671