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PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN 401k Plan overview

Plan NamePATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN
Plan identification number 501

PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PATRIOT SUBARU OF NORTH ATTLEBORO has sponsored the creation of one or more 401k plans.

Company Name:PATRIOT SUBARU OF NORTH ATTLEBORO
Employer identification number (EIN):465579742
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-09-01SUSAN MAURICE2024-01-24
5012021-09-01SUSAN MAURICE2023-01-26

Plan Statistics for PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN

401k plan membership statisitcs for PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN

Measure Date Value
2022: PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-09-01132
Total number of active participants reported on line 7a of the Form 55002022-09-01140
Number of retired or separated participants receiving benefits2022-09-010
Number of other retired or separated participants entitled to future benefits2022-09-010
Total of all active and inactive participants2022-09-01140
Number of employers contributing to the scheme2022-09-010
2021: PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01133
Total number of active participants reported on line 7a of the Form 55002021-09-01132
Number of retired or separated participants receiving benefits2021-09-010
Number of other retired or separated participants entitled to future benefits2021-09-010
Total of all active and inactive participants2021-09-01132
Number of employers contributing to the scheme2021-09-010

Form 5500 Responses for PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN

2022: PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-09-01Type of plan entitySingle employer plan
2022-09-01Plan funding arrangement – InsuranceYes
2022-09-01Plan funding arrangement – General assets of the sponsorYes
2022-09-01Plan benefit arrangement – InsuranceYes
2022-09-01Plan benefit arrangement – General assets of the sponsorYes
2021: PATRIOT SUBARU OF NORTH ATTLEBORO WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number13493
Policy instance 1
Insurance contract or identification number13493
Number of Individuals Covered202
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $3,190
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,190
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number503879
Policy instance 2
Insurance contract or identification number503879
Number of Individuals Covered140
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $8,363
Total amount of fees paid to insurance companyUSD $747
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $76,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,363
Amount paid for insurance broker fees747
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number013493
Policy instance 1
Insurance contract or identification number013493
Number of Individuals Covered193
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,917
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,917
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number503879
Policy instance 2
Insurance contract or identification number503879
Number of Individuals Covered132
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $6,738
Total amount of fees paid to insurance companyUSD $1,615
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $61,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $6,491
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1084180002
Policy instance 3
Insurance contract or identification number1084180002
Number of Individuals Covered193
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $45,742
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $1,031,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $33,588
Amount paid for insurance broker fees0
Insurance broker organization code?3

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