401k Plan data: WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN plan

WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN
Plan identification number	505

WASABI TECHNOLOGIES LLC 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

WASABI TECHNOLOGIES LLC has sponsored the creation of one or more 401k plans.

Company Name: WASABI TECHNOLOGIES LLC

Employer identification number (EIN): 811335285

NAIC Classification: 541519
NAIC Description: Other Computer Related Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2022-11-01

Plan Statistics for WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN

Measure Date Value
2022: WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-11-01 204
Total number of active participants reported on line 7a of the Form 5500 2022-11-01 263
Number of retired or separated participants receiving benefits 2022-11-01 0
Number of other retired or separated participants entitled to future benefits 2022-11-01 0
Total of all active and inactive participants 2022-11-01 263

Measure	Date	Value
2022: WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-11-01	204
Total number of active participants reported on line 7a of the Form 5500	2022-11-01	263
Number of retired or separated participants receiving benefits	2022-11-01	0
Number of other retired or separated participants entitled to future benefits	2022-11-01	0
Total of all active and inactive participants	2022-11-01	263

Form 5500 Responses for WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN

2022: WASABI TECHNOLOGIES LLC HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-11-01	Type of plan entity	Single employer plan
2022-11-01	First time form 5500 has been submitted	Yes
2022-11-01	Submission has been amended	No
2022-11-01	This submission is the final filing	No
2022-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-11-01	Plan is a collectively bargained plan	No
2022-11-01	Plan funding arrangement – Insurance	Yes
2022-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-11-01	Plan benefit arrangement – Insurance	Yes
2022-11-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

8070802

Policy instance

Insurance contract or identification number	8070802
Number of Individuals Covered	483
Insurance policy start date	2022-11-01
Insurance policy end date	2023-10-31
Total amount of commissions paid to insurance broker	USD $46,698
Total amount of fees paid to insurance company	USD $14,122
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,698
Amount paid for insurance broker fees	14122
Additional information about fees paid to insurance broker	OTHER COMMISSION/NON-MONETARY COMPENSATION
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

886391G

Policy instance

Insurance contract or identification number	861472
Number of Individuals Covered	1567
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $31,772
Total amount of fees paid to insurance company	USD $80,865
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,393,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,772
Amount paid for insurance broker fees	80865
Additional information about fees paid to insurance broker	DIRECT COMPENSATION, INDIRECT COMPENSATION
Insurance broker organization code?	3
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
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30088366

Policy instance

Insurance contract or identification number	30088366
Number of Individuals Covered	192
Insurance policy start date	2022-11-01
Insurance policy end date	2023-10-31
Total amount of commissions paid to insurance broker	USD $1,391
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
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 $24,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,267
Insurance broker organization code?	3

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Company Name:	WASABI TECHNOLOGIES LLC
Employer identification number (EIN):	811335285
NAIC Classification:	541519
NAIC Description:	Other Computer Related Services