401k Plan data: MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN plan

MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN
Plan identification number	501

MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

MADISON UNITED HEALTHCARE LINEN, LTD. has sponsored the creation of one or more 401k plans.

Company Name: MADISON UNITED HEALTHCARE LINEN, LTD.

Employer identification number (EIN): 391091317

NAIC Classification: 812320
NAIC Description: Drycleaning and Laundry Services (except Coin-Operated)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-05-01

Plan Statistics for MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN

401k plan membership statisitcs for MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN

Measure Date Value
2021: MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-05-01 103
Total number of active participants reported on line 7a of the Form 5500 2021-05-01 96
Total of all active and inactive participants 2021-05-01 96

Measure	Date	Value
2021: MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-05-01	103
Total number of active participants reported on line 7a of the Form 5500	2021-05-01	96
Total of all active and inactive participants	2021-05-01	96

Form 5500 Responses for MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN

2021: MADISON UNITED HEALTH CARE LINEN WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	First time form 5500 has been submitted	Yes
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-05-01	Plan benefit arrangement – Insurance	Yes
2021-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )

Policy contract number

09110 00000

Policy instance

Insurance contract or identification number	09110 00000
Number of Individuals Covered	57
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $2,642
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,642
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010202859 00

Policy instance

Insurance contract or identification number	000010202859 00
Number of Individuals Covered	94
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $1,287
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,287
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010202861 00

Policy instance

Insurance contract or identification number	000010202861 00
Number of Individuals Covered	96
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $2,775
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,775
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010202860 00

Policy instance

Insurance contract or identification number	000010202860 00
Number of Individuals Covered	11
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $758
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $758
Insurance broker organization code?	3

GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN (National Association of Insurance Commissioners NAIC id number: 95311 )

Policy contract number

CORP ID 411

Policy instance

Insurance contract or identification number	CORP ID 411
Number of Individuals Covered	85
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $29,990
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $621,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,990
Insurance broker organization code?	3

UNITY HEALTH PLANS INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95796 )

Policy contract number

900316

Policy instance

Insurance contract or identification number	900316
Number of Individuals Covered	25
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $8,594
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $433,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,594
Insurance broker organization code?	3

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Company Name:	MADISON UNITED HEALTHCARE LINEN, LTD.
Employer identification number (EIN):	391091317
NAIC Classification:	812320
NAIC Description:	Drycleaning and Laundry Services (except Coin-Operated)