401k Plan data: OVATIVE GROUP, LLC HEALTH & WELFARE PLAN plan

OVATIVE GROUP, LLC HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	OVATIVE GROUP, LLC HEALTH & WELFARE PLAN
Plan identification number	510

OVATIVE GROUP, LLC HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

OVATIVE GROUP LLC has sponsored the creation of one or more 401k plans.

Company Name: OVATIVE GROUP LLC

Employer identification number (EIN): 271175614

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OVATIVE GROUP, LLC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2022-01-01 ELIZABETH MOSINIAK 2023-07-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
510	2022-01-01	ELIZABETH MOSINIAK	2023-07-20

Plan Statistics for OVATIVE GROUP, LLC HEALTH & WELFARE PLAN

401k plan membership statisitcs for OVATIVE GROUP, LLC HEALTH & WELFARE PLAN

Measure Date Value
2022: OVATIVE GROUP, LLC HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 282
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 437
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 437
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: OVATIVE GROUP, LLC HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	282
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	437
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	437
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for OVATIVE GROUP, LLC HEALTH & WELFARE PLAN

2022: OVATIVE GROUP, LLC HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )

Policy contract number

309448

Policy instance

Insurance contract or identification number	309448
Number of Individuals Covered	590
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $80,249
Total amount of fees paid to insurance company	USD $1,484
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,531,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80,249
Amount paid for insurance broker fees	1484
Additional information about fees paid to insurance broker	BROKER INCENTIVE PROGRAM
Insurance broker organization code?	3

DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )

Policy contract number

855592

Policy instance

Insurance contract or identification number	855592
Number of Individuals Covered	592
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $22,866
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?	No
Commission paid to Insurance Broker	USD $22,866
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1024565

Policy instance

Insurance contract or identification number	1024565
Number of Individuals Covered	494
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $12,924
Total amount of fees paid to insurance company	USD $0
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 $250,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,924
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30062033

Policy instance

Insurance contract or identification number	30062033
Number of Individuals Covered	260
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,513
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,513
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	OVATIVE GROUP LLC
Employer identification number (EIN):	271175614
NAIC Classification:	541600