401k Plan data: OMEDA HOLDINGS, LLC plan

OMEDA HOLDINGS, LLC 401k Plan overview

Plan Name	OMEDA HOLDINGS, LLC
Plan identification number	501

OMEDA HOLDINGS, LLC 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

OMEDA HOLDINGS, LLC has sponsored the creation of one or more 401k plans.

Company Name: OMEDA HOLDINGS, LLC

Employer identification number (EIN): 811546883

NAIC Classification: 518210
NAIC Description: Data Processing, Hosting, and Related Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OMEDA HOLDINGS, LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01 SUZANNE POLERECKY 2020-05-19
501 2018-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01	SUZANNE POLERECKY	2020-05-19
501	2018-01-01

Plan Statistics for OMEDA HOLDINGS, LLC

401k plan membership statisitcs for OMEDA HOLDINGS, LLC

Measure Date Value
2019: OMEDA HOLDINGS, LLC 2019 401k membership
Total participants, beginning-of-year 2019-01-01 205
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 144
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 2019-01-01 144
Number of employers contributing to the scheme 2019-01-01 0
2018: OMEDA HOLDINGS, LLC 2018 401k membership
Total participants, beginning-of-year 2018-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 201
Number of retired or separated participants receiving benefits 2018-01-01 4
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 205
Number of employers contributing to the scheme 2018-01-01 0

Measure	Date	Value
2019: OMEDA HOLDINGS, LLC 2019 401k membership
Total participants, beginning-of-year	2019-01-01	205
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	144
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	144
Number of employers contributing to the scheme	2019-01-01	0
2018: OMEDA HOLDINGS, LLC 2018 401k membership
Total participants, beginning-of-year	2018-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	201
Number of retired or separated participants receiving benefits	2018-01-01	4
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	205
Number of employers contributing to the scheme	2018-01-01	0

Form 5500 Responses for OMEDA HOLDINGS, LLC

2019: OMEDA HOLDINGS, LLC 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: OMEDA HOLDINGS, LLC 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	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

217448

Policy instance

Insurance contract or identification number	217448
Number of Individuals Covered	205
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $49,887
Total amount of fees paid to insurance company	USD $530
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,262,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $49,887
Amount paid for insurance broker fees	530
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10238757

Policy instance

Insurance contract or identification number	10238757
Number of Individuals Covered	144
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $12,416
Total amount of fees paid to insurance company	USD $0
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $144,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,416
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

217448

Policy instance

Insurance contract or identification number	217448
Number of Individuals Covered	201
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $47,996
Total amount of fees paid to insurance company	USD $870
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,244,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $47,996
Amount paid for insurance broker fees	870
Additional information about fees paid to insurance broker	OTHER COMMISSIONS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10238757

Policy instance

Insurance contract or identification number	10238757
Number of Individuals Covered	138
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,425
Total amount of fees paid to insurance company	USD $0
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $141,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,425
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	OMEDA HOLDINGS, LLC
Employer identification number (EIN):	811546883
NAIC Classification:	518210
NAIC Description:	Data Processing, Hosting, and Related Services