401k Plan data: NMIS HEALTH AND WELFARE PLAN plan

NMIS HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	NMIS HEALTH AND WELFARE PLAN
Plan identification number	501

NMIS HEALTH AND WELFARE 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) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

NETWORK MERCHANTS, LLC has sponsored the creation of one or more 401k plans.

Company Name: NETWORK MERCHANTS, LLC

Employer identification number (EIN): 800950412

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-12-01 KIM NORWESH 2023-08-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-12-01	KIM NORWESH	2023-08-07

Plan Statistics for NMIS HEALTH AND WELFARE PLAN

401k plan membership statisitcs for NMIS HEALTH AND WELFARE PLAN

Measure Date Value
2021: NMIS HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-12-01 195
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 215
Number of retired or separated participants receiving benefits 2021-12-01 2
Number of other retired or separated participants entitled to future benefits 2021-12-01 28
Total of all active and inactive participants 2021-12-01 245
Number of employers contributing to the scheme 2021-12-01 0

Measure	Date	Value
2021: NMIS HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	195
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	215
Number of retired or separated participants receiving benefits	2021-12-01	2
Number of other retired or separated participants entitled to future benefits	2021-12-01	28
Total of all active and inactive participants	2021-12-01	245
Number of employers contributing to the scheme	2021-12-01	0

Form 5500 Responses for NMIS HEALTH AND WELFARE PLAN

2021: NMIS HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	First time form 5500 has been submitted	Yes
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

P60845 P60846

Policy instance

Insurance contract or identification number	P60845 P60846
Number of Individuals Covered	388
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $89,489
Total amount of fees paid to insurance company	USD $1,975
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,912,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $74,261
Amount paid for insurance broker fees	1975
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

921942-000

Policy instance

Insurance contract or identification number	921942-000
Number of Individuals Covered	378
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $6,700
Total amount of fees paid to insurance company	USD $1,036
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $6,700
Amount paid for insurance broker fees	1036
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

541378

Policy instance

Insurance contract or identification number	541378
Number of Individuals Covered	162
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $1,248
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,248
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

947467

Policy instance

Insurance contract or identification number	947467
Number of Individuals Covered	60
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $667
Total amount of fees paid to insurance company	USD $198
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $5,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $667
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0BHFK

Policy instance

Insurance contract or identification number	GLTD0BHFK
Number of Individuals Covered	211
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $5,185
Total amount of fees paid to insurance company	USD $2,995
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $51,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,185
Amount paid for insurance broker fees	2995
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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Company Name:	NETWORK MERCHANTS, LLC
Employer identification number (EIN):	800950412
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services