401k Plan data: XEBIA HEALTH AND WELFARE BENEFIT PLAN plan

XEBIA HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	XEBIA HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

XEBIA HEALTH AND 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) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

XEBIA USA INC has sponsored the creation of one or more 401k plans.

Company Name: XEBIA USA INC

Employer identification number (EIN): 455560973

NAIC Classification: 541519
NAIC Description: Other Computer Related Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan XEBIA HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-06-01 KENNETH STEWART 2025-01-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-06-01	KENNETH STEWART	2025-01-16

Form 5500 Responses for XEBIA HEALTH AND WELFARE BENEFIT PLAN

2023: XEBIA HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-06-01	Type of plan entity	Single employer plan
2023-06-01	First time form 5500 has been submitted	Yes
2023-06-01	Plan funding arrangement – Insurance	Yes
2023-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-06-01	Plan benefit arrangement – Insurance	Yes
2023-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

51807

Policy instance

Insurance contract or identification number	51807
Number of Individuals Covered	103
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $50,055
Total amount of fees paid to insurance company	USD $9,262
Dental Insurance Welfare Benefit	Yes
Vision 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, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $299,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

163093

Policy instance

Insurance contract or identification number	163093
Number of Individuals Covered	17
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $849
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $2,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

625385

Policy instance

Insurance contract or identification number	625385
Number of Individuals Covered	245
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $87,578
Total amount of fees paid to insurance company	USD $4,790
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	XEBIA USA INC
Employer identification number (EIN):	455560973
NAIC Classification:	541519
NAIC Description:	Other Computer Related Services