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UNDER CANVAS, INC. HEALTH & WELFARE PLAN 401k Plan overview

Plan NameUNDER CANVAS, INC. HEALTH & WELFARE PLAN
Plan identification number 501

UNDER CANVAS, INC. HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Prepaid legal
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

UNDER CANVAS, INC. has sponsored the creation of one or more 401k plans.

Company Name:UNDER CANVAS, INC.
Employer identification number (EIN):264513836
NAIC Classification:721110
NAIC Description:Hotels (except Casino Hotels) and Motels

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNDER CANVAS, INC. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01SEAN RUSH2024-07-25
5012022-01-01ALYSHA JEFFERY2023-09-25
5012021-01-01ALYSHA JEFFERY2022-08-04
5012020-02-01ALYSHA JEFFERY2021-07-23

Plan Statistics for UNDER CANVAS, INC. HEALTH & WELFARE PLAN

401k plan membership statisitcs for UNDER CANVAS, INC. HEALTH & WELFARE PLAN

Measure Date Value
2023: UNDER CANVAS, INC. HEALTH & WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01150
Total number of active participants reported on line 7a of the Form 55002023-01-01131
Number of retired or separated participants receiving benefits2023-01-012
Number of other retired or separated participants entitled to future benefits2023-01-0173
Total of all active and inactive participants2023-01-01206
Number of employers contributing to the scheme2023-01-010
2022: UNDER CANVAS, INC. HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01147
Total number of active participants reported on line 7a of the Form 55002022-01-01124
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0126
Total of all active and inactive participants2022-01-01150
Number of employers contributing to the scheme2022-01-010
2021: UNDER CANVAS, INC. HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01139
Total number of active participants reported on line 7a of the Form 55002021-01-01115
Number of retired or separated participants receiving benefits2021-01-0110
Number of other retired or separated participants entitled to future benefits2021-01-0122
Total of all active and inactive participants2021-01-01147
Number of employers contributing to the scheme2021-01-010
2020: UNDER CANVAS, INC. HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01128
Total number of active participants reported on line 7a of the Form 55002020-02-01110
Number of retired or separated participants receiving benefits2020-02-013
Number of other retired or separated participants entitled to future benefits2020-02-0126
Total of all active and inactive participants2020-02-01139
Number of employers contributing to the scheme2020-02-010

Form 5500 Responses for UNDER CANVAS, INC. HEALTH & WELFARE PLAN

2023: UNDER CANVAS, INC. HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: UNDER CANVAS, INC. HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: UNDER CANVAS, INC. HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: UNDER CANVAS, INC. HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01First time form 5500 has been submittedYes
2020-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number213835
Policy instance 1
Insurance contract or identification number213835
Number of Individuals Covered176
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $52,415
Total amount of fees paid to insurance companyUSD $2,351
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $958,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberVF027110
Policy instance 2
Insurance contract or identification numberVF027110
Number of Individuals Covered195
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $10,419
Total amount of fees paid to insurance companyUSD $3,292
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $95,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number302820
Policy instance 3
Insurance contract or identification number302820
Number of Individuals Covered10
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $211
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $1,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number213835
Policy instance 1
Insurance contract or identification number213835
Number of Individuals Covered174
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $48,796
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $919,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberVF027110
Policy instance 2
Insurance contract or identification numberVF027110
Number of Individuals Covered232
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,731
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $93,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number302820
Policy instance 3
Insurance contract or identification number302820
Number of Individuals Covered12
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $441
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number213835
Policy instance 1
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number213835
Policy instance 1

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