401k Plan data: EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN plan

EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN
Plan identification number	501

EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

EXAMSOFT WORLDWIDE INC. has sponsored the creation of one or more 401k plans.

Company Name: EXAMSOFT WORLDWIDE INC.

Employer identification number (EIN): 650836105

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-01-01 AMBER RUST 2021-09-21
501 2020-01-01 AMBER RUST 2022-08-01
501 2019-01-01 AMBER RUST 2020-09-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2020-01-01	AMBER RUST	2021-09-21
501	2020-01-01	AMBER RUST	2022-08-01
501	2019-01-01	AMBER RUST	2020-09-21

Plan Statistics for EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN

Measure Date Value
2020: EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 127
Total of all active and inactive participants 2020-01-01 127
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
2019: EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 127
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 127
Number of employers contributing to the scheme 2019-01-01 0

Measure	Date	Value
2020: EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	127
Total of all active and inactive participants	2020-01-01	127
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
2019: EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	127
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	127
Number of employers contributing to the scheme	2019-01-01	0

Form 5500 Responses for EXAMSOFT WORLDWIDE EMPLOYEE BENEFITS PLAN

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

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

283880

Policy instance

Insurance contract or identification number	283880
Number of Individuals Covered	336
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $76,074
Total amount of fees paid to insurance company	USD $0
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 $1,470,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $76,074
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

B9085

Policy instance

Insurance contract or identification number	B9085
Number of Individuals Covered	124
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $51,473
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,567
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

B9085

Policy instance

Insurance contract or identification number	B9085
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,508
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,156
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	EXAMSOFT WORLDWIDE INC.
Employer identification number (EIN):	650836105
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services