401k Plan data: TAWANI ENTERPRISES, INC HEALTH AND WELFARE PLANS plan

TAWANI ENTERPRISES, INC HEALTH AND WELFARE PLANS 401k Plan overview

Plan Name	TAWANI ENTERPRISES, INC HEALTH AND WELFARE PLANS
Plan identification number	501

TAWANI ENTERPRISES, INC HEALTH AND WELFARE PLANS 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) Other welfare benefit cover

401k Sponsoring company profile

TAWANI ENTERPRISES, INC. has sponsored the creation of one or more 401k plans.

Company Name: TAWANI ENTERPRISES, INC.

Employer identification number (EIN): 364083425

NAIC Classification: 812990
NAIC Description: All Other Personal Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAWANI ENTERPRISES, INC HEALTH AND WELFARE PLANS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 NICOLE PETTIS 2024-10-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	NICOLE PETTIS	2024-10-09

Form 5500 Responses for TAWANI ENTERPRISES, INC HEALTH AND WELFARE PLANS

2023: TAWANI ENTERPRISES, INC HEALTH AND WELFARE PLANS 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

88331

Policy instance

Insurance contract or identification number	88331
Number of Individuals Covered	180
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $62,064
Total amount of fees paid to insurance company	USD $2,325
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,577,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

1086979

Policy instance

Insurance contract or identification number	1086979
Number of Individuals Covered	186
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $13,893
Total amount of fees paid to insurance company	USD $6,701
Dental Insurance Welfare Benefit	Yes
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, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $176,148
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: 12516 )

Policy contract number

30080154

Policy instance

Insurance contract or identification number	30080154
Number of Individuals Covered	87
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $425
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TAWANI ENTERPRISES, INC.
Employer identification number (EIN):	364083425
NAIC Classification:	812990
NAIC Description:	All Other Personal Services