BLOCK 22, LLC HEALTH AND WELFARE PLAN 401k Plan overview
| Plan Name | BLOCK 22, LLC HEALTH AND WELFARE PLAN |
| Plan identification number | 506 |
BLOCK 22, 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)
- Other welfare benefit cover
|
401k Sponsoring company profile
BLOCK 22, LLC has sponsored the creation of one or more 401k plans.
| Company Name: | BLOCK 22, LLC |
| Employer identification number (EIN): | 820485635 |
| NAIC Classification: | 721110 |
| NAIC Description: | Hotels (except Casino Hotels) and Motels |
Additional information about BLOCK 22, LLC
| Jurisdiction of Incorporation: | Idaho Secretary Of State |
| Incorporation Date: | |
| Company Identification Number: | W1312 |
More information about BLOCK 22, LLC
Form 5500 Filing Information
Submission information for form 5500 for 401k plan BLOCK 22, LLC HEALTH AND WELFARE PLAN
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 506 | 2023-09-01 | MICHAEL R. CAMPBELL | 2024-07-01 | | |
Plan Statistics for BLOCK 22, LLC HEALTH AND WELFARE PLAN
401k plan membership statisitcs for BLOCK 22, LLC HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2023: BLOCK 22, LLC HEALTH AND WELFARE PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-09-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-09-01 | 109 |
| Number of retired or separated participants receiving benefits | 2023-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-09-01 | 0 |
| Total of all active and inactive participants | 2023-09-01 | 109 |
| Number of employers contributing to the scheme | 2023-09-01 | 0 |
Form 5500 Responses for BLOCK 22, LLC HEALTH AND WELFARE PLAN
| 2023: BLOCK 22, LLC HEALTH AND WELFARE PLAN 2023 form 5500 responses |
|---|
| 2023-09-01 | Type of plan entity | Single employer plan |
| 2023-09-01 | First time form 5500 has been submitted | Yes |
| 2023-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2023-09-01 | Plan funding arrangement – Insurance | Yes |
| 2023-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
Insurance Providers Used on plan
| BLUE CROSS OF IDAHO HEALTH SERVICE INC. (National Association of Insurance Commissioners NAIC id number: 60095 ) |
| Policy contract number | 10034919 |
| Policy instance | 1 |
| Insurance contract or identification number | 10034919 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $34,138 | | Total amount of fees paid to insurance company | USD $4,620 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $163,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 ) |
| Policy contract number | 4761 |
| Policy instance | 2 |
| Insurance contract or identification number | 4761 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 11333 |
| Policy instance | 3 |
| Insurance contract or identification number | 11333 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $6,380 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $69,289 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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