401k Plan data: INTERSIGN CORPORATION WELFARE BENEFITS plan

INTERSIGN CORPORATION WELFARE BENEFITS 401k Plan overview

Plan Name	INTERSIGN CORPORATION WELFARE BENEFITS
Plan identification number	501

INTERSIGN CORPORATION WELFARE BENEFITS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Other welfare benefit cover

401k Sponsoring company profile

INTERSIGN CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: INTERSIGN CORPORATION

Employer identification number (EIN): 621327520

NAIC Classification: 323100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INTERSIGN CORPORATION WELFARE BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-03-01 TINA BELAU
501 2023-03-01 TINA BELAU
501 2022-03-01
501 2022-03-01 TINA BELAU
501 2021-03-01 TINA BELAU 2022-08-12
501 2020-03-01 TINA BELAU 2022-08-12
501 2019-03-01 TINA BELAU 2022-08-12
501 2018-03-01 TINA BELAU 2022-08-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2024-03-01	TINA BELAU
501	2023-03-01	TINA BELAU
501	2022-03-01
501	2022-03-01	TINA BELAU
501	2021-03-01	TINA BELAU	2022-08-12
501	2020-03-01	TINA BELAU	2022-08-12
501	2019-03-01	TINA BELAU	2022-08-12
501	2018-03-01	TINA BELAU	2022-08-12

Plan Statistics for INTERSIGN CORPORATION WELFARE BENEFITS

401k plan membership statisitcs for INTERSIGN CORPORATION WELFARE BENEFITS

Measure Date Value
2022: INTERSIGN CORPORATION WELFARE BENEFITS 2022 401k membership
Total participants, beginning-of-year 2022-03-01 108
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 129
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 129
2021: INTERSIGN CORPORATION WELFARE BENEFITS 2021 401k membership
Total participants, beginning-of-year 2021-03-01 165
Total number of active participants reported on line 7a of the Form 5500 2021-03-01 163
Number of retired or separated participants receiving benefits 2021-03-01 0
Number of other retired or separated participants entitled to future benefits 2021-03-01 0
Total of all active and inactive participants 2021-03-01 163
2020: INTERSIGN CORPORATION WELFARE BENEFITS 2020 401k membership
Total participants, beginning-of-year 2020-03-01 187
Total number of active participants reported on line 7a of the Form 5500 2020-03-01 163
Number of retired or separated participants receiving benefits 2020-03-01 0
Number of other retired or separated participants entitled to future benefits 2020-03-01 0
Total of all active and inactive participants 2020-03-01 163
2019: INTERSIGN CORPORATION WELFARE BENEFITS 2019 401k membership
Total participants, beginning-of-year 2019-03-01 176
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 189
Number of retired or separated participants receiving benefits 2019-03-01 0
Number of other retired or separated participants entitled to future benefits 2019-03-01 0
Total of all active and inactive participants 2019-03-01 189
2018: INTERSIGN CORPORATION WELFARE BENEFITS 2018 401k membership
Total participants, beginning-of-year 2018-03-01 143
Total number of active participants reported on line 7a of the Form 5500 2018-03-01 140
Number of retired or separated participants receiving benefits 2018-03-01 0
Number of other retired or separated participants entitled to future benefits 2018-03-01 0
Total of all active and inactive participants 2018-03-01 140

Measure	Date	Value
2022: INTERSIGN CORPORATION WELFARE BENEFITS 2022 401k membership
Total participants, beginning-of-year	2022-03-01	108
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	129
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	129
2021: INTERSIGN CORPORATION WELFARE BENEFITS 2021 401k membership
Total participants, beginning-of-year	2021-03-01	165
Total number of active participants reported on line 7a of the Form 5500	2021-03-01	163
Number of retired or separated participants receiving benefits	2021-03-01	0
Number of other retired or separated participants entitled to future benefits	2021-03-01	0
Total of all active and inactive participants	2021-03-01	163
2020: INTERSIGN CORPORATION WELFARE BENEFITS 2020 401k membership
Total participants, beginning-of-year	2020-03-01	187
Total number of active participants reported on line 7a of the Form 5500	2020-03-01	163
Number of retired or separated participants receiving benefits	2020-03-01	0
Number of other retired or separated participants entitled to future benefits	2020-03-01	0
Total of all active and inactive participants	2020-03-01	163
2019: INTERSIGN CORPORATION WELFARE BENEFITS 2019 401k membership
Total participants, beginning-of-year	2019-03-01	176
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	189
Number of retired or separated participants receiving benefits	2019-03-01	0
Number of other retired or separated participants entitled to future benefits	2019-03-01	0
Total of all active and inactive participants	2019-03-01	189
2018: INTERSIGN CORPORATION WELFARE BENEFITS 2018 401k membership
Total participants, beginning-of-year	2018-03-01	143
Total number of active participants reported on line 7a of the Form 5500	2018-03-01	140
Number of retired or separated participants receiving benefits	2018-03-01	0
Number of other retired or separated participants entitled to future benefits	2018-03-01	0
Total of all active and inactive participants	2018-03-01	140

Form 5500 Responses for INTERSIGN CORPORATION WELFARE BENEFITS

2022: INTERSIGN CORPORATION WELFARE BENEFITS 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Submission has been amended	Yes
2022-03-01	This submission is the final filing	No
2022-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-03-01	Plan is a collectively bargained plan	No
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes
2021: INTERSIGN CORPORATION WELFARE BENEFITS 2021 form 5500 responses
2021-03-01	Type of plan entity	Single employer plan
2021-03-01	Submission has been amended	No
2021-03-01	This submission is the final filing	No
2021-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-03-01	Plan is a collectively bargained plan	No
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes
2020: INTERSIGN CORPORATION WELFARE BENEFITS 2020 form 5500 responses
2020-03-01	Type of plan entity	Single employer plan
2020-03-01	Submission has been amended	No
2020-03-01	This submission is the final filing	No
2020-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-03-01	Plan is a collectively bargained plan	No
2020-03-01	Plan funding arrangement – Insurance	Yes
2020-03-01	Plan benefit arrangement – Insurance	Yes
2019: INTERSIGN CORPORATION WELFARE BENEFITS 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	Submission has been amended	No
2019-03-01	This submission is the final filing	No
2019-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-03-01	Plan is a collectively bargained plan	No
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes
2018: INTERSIGN CORPORATION WELFARE BENEFITS 2018 form 5500 responses
2018-03-01	Type of plan entity	Single employer plan
2018-03-01	First time form 5500 has been submitted	Yes
2018-03-01	Submission has been amended	No
2018-03-01	This submission is the final filing	No
2018-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-03-01	Plan is a collectively bargained plan	No
2018-03-01	Plan funding arrangement – Insurance	Yes
2018-03-01	Plan benefit arrangement – Insurance	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

00048437

Policy instance

Insurance contract or identification number	00048437
Number of Individuals Covered	190
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $21,500
Total amount of fees paid to insurance company	USD $2,432
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
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	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	VOLUNTARY HOSPITAL INDEMNITY, VOLUNTARY CRITICAL ILLNESS, OPTIONAL LIFE, CANCER, AD&D, ACCIDENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $158,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

931052

Policy instance

Insurance contract or identification number	931052
Number of Individuals Covered	163
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $42,223
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $802,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50005713

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

87873

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

87873

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50005713

Policy instance

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0921091

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50005713

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

87873

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50005713

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

87873

Policy instance

Potentially related plans

INTERSIGN CORPORATION WELFARE BENEFITS [EIN = 627327520]

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Company Name:	INTERSIGN CORPORATION
Employer identification number (EIN):	621327520
NAIC Classification:	323100