401k Plan data: INDICOR, LLC WELFARE BENEFIT PLAN plan

INDICOR, LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	INDICOR, LLC WELFARE BENEFIT PLAN
Plan identification number	501

INDICOR, LLC WELFARE BENEFIT 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) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: INDICOR LLC

Employer identification number (EIN): 421445752

NAIC Classification: 551112
NAIC Description: Offices of Other Holding Companies

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDICOR, LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-07-01 JENNIFER WEI 2024-10-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-07-01	JENNIFER WEI	2024-10-03

Plan Statistics for INDICOR, LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for INDICOR, LLC WELFARE BENEFIT PLAN

Measure Date Value
2023: INDICOR, LLC WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2023-07-01 1,213
Number of retired or separated participants receiving benefits 2023-07-01 14
Number of other retired or separated participants entitled to future benefits 2023-07-01 0
Total of all active and inactive participants 2023-07-01 1,227
Number of employers contributing to the scheme 2023-07-01 0

Measure	Date	Value
2023: INDICOR, LLC WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2023-07-01	1,213
Number of retired or separated participants receiving benefits	2023-07-01	14
Number of other retired or separated participants entitled to future benefits	2023-07-01	0
Total of all active and inactive participants	2023-07-01	1,227
Number of employers contributing to the scheme	2023-07-01	0

Form 5500 Responses for INDICOR, LLC WELFARE BENEFIT PLAN

2023: INDICOR, LLC WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	First time form 5500 has been submitted	Yes
2023-07-01	Submission has been amended	Yes
2023-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

22288

Policy instance

Insurance contract or identification number	22288
Number of Individuals Covered	2193
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $25,240
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $333,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

40154982

Policy instance

Insurance contract or identification number	40154982
Number of Individuals Covered	904
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,151
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COUNSELING GLOBAL DOMESTIC (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

632157

Policy instance

Insurance contract or identification number	632157
Number of Individuals Covered	1155
Insurance policy start date	2023-07-01
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 $15,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

C51722

Policy instance

Insurance contract or identification number	C51722
Number of Individuals Covered	161
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $13,465
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $896,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

SA2890LF109601

Policy instance

Insurance contract or identification number	SA2890LF109601
Number of Individuals Covered	1213
Insurance policy start date	2023-07-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $28,276
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,988,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	INDICOR LLC
Employer identification number (EIN):	421445752
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies