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| Plan Name | TYBER MEDICAL, LLC EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | TYBER MEDICAL LLC |
| Employer identification number (EIN): | 460535658 |
| NAIC Classification: | 339110 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-10-01 | TOBY BORCOMAN | |||
| 501 | 2022-10-01 | ||||
| 501 | 2022-10-01 | TOBY BORCOMAN |
| Measure | Date | Value |
|---|---|---|
| 2022: TYBER MEDICAL, LLC EMPLOYEE BENEFIT PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-10-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 179 |
| Number of retired or separated participants receiving benefits | 2022-10-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2022-10-01 | 0 |
| Total of all active and inactive participants | 2022-10-01 | 185 |
| 2022: TYBER MEDICAL, LLC EMPLOYEE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | First time form 5500 has been submitted | Yes |
| 2022-10-01 | Submission has been amended | No |
| 2022-10-01 | This submission is the final filing | No |
| 2022-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-10-01 | Plan is a collectively bargained plan | No |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 00637031 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67601 ) | |
| Policy contract number | 917033 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 917031 |
| Policy instance | 3 |
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) | |
| Policy contract number | 917032 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 917030 |
| Policy instance | 5 |
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) | |
| Policy contract number | 917034 |
| Policy instance | 6 |
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