401k Plan data: plan

Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-07-01 MIRA HWANG 2025-01-09
501 2022-07-01 MIRA HWANG 2023-10-02
501 2021-07-01 MIRA HWANG 2022-12-07
501 2020-07-01 MIRA HWANG 2021-11-16
501 2020-07-01 MIRA HWANG 2022-11-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-07-01	MIRA HWANG	2025-01-09
501	2022-07-01	MIRA HWANG	2023-10-02
501	2021-07-01	MIRA HWANG	2022-12-07
501	2020-07-01	MIRA HWANG	2021-11-16
501	2020-07-01	MIRA HWANG	2022-11-08

Plan Statistics for

401k plan membership statisitcs for

Measure Date Value
2023: 2023 401k membership
Total participants, beginning-of-year 2023-07-01 79
Total number of active participants reported on line 7a of the Form 5500 2023-07-01 67
Number of retired or separated participants receiving benefits 2023-07-01 0
Number of other retired or separated participants entitled to future benefits 2023-07-01 0
Total of all active and inactive participants 2023-07-01 67
Number of employers contributing to the scheme 2023-07-01 0
2022: 2022 401k membership
Total participants, beginning-of-year 2022-07-01 110
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 103
Number of retired or separated participants receiving benefits 2022-07-01 1
Number of other retired or separated participants entitled to future benefits 2022-07-01 6
Total of all active and inactive participants 2022-07-01 110
Number of employers contributing to the scheme 2022-07-01 0
2021: 2021 401k membership
Total participants, beginning-of-year 2021-07-01 126
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 112
Number of retired or separated participants receiving benefits 2021-07-01 1
Number of other retired or separated participants entitled to future benefits 2021-07-01 7
Total of all active and inactive participants 2021-07-01 120
Number of employers contributing to the scheme 2021-07-01 0
2020: 2020 401k membership
Total participants, beginning-of-year 2020-07-01 112
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 122
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 7
Total of all active and inactive participants 2020-07-01 129
Number of employers contributing to the scheme 2020-07-01 0

Measure	Date	Value
2023: 2023 401k membership
Total participants, beginning-of-year	2023-07-01	79
Total number of active participants reported on line 7a of the Form 5500	2023-07-01	67
Number of retired or separated participants receiving benefits	2023-07-01	0
Number of other retired or separated participants entitled to future benefits	2023-07-01	0
Total of all active and inactive participants	2023-07-01	67
Number of employers contributing to the scheme	2023-07-01	0
2022: 2022 401k membership
Total participants, beginning-of-year	2022-07-01	110
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	103
Number of retired or separated participants receiving benefits	2022-07-01	1
Number of other retired or separated participants entitled to future benefits	2022-07-01	6
Total of all active and inactive participants	2022-07-01	110
Number of employers contributing to the scheme	2022-07-01	0
2021: 2021 401k membership
Total participants, beginning-of-year	2021-07-01	126
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	112
Number of retired or separated participants receiving benefits	2021-07-01	1
Number of other retired or separated participants entitled to future benefits	2021-07-01	7
Total of all active and inactive participants	2021-07-01	120
Number of employers contributing to the scheme	2021-07-01	0
2020: 2020 401k membership
Total participants, beginning-of-year	2020-07-01	112
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	122
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	7
Total of all active and inactive participants	2020-07-01	129
Number of employers contributing to the scheme	2020-07-01	0

Form 5500 Responses for

2023: 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	Yes
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30076917

Policy instance

Insurance contract or identification number	30076917
Number of Individuals Covered	36
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $428
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952518

Policy instance

Insurance contract or identification number	5952518
Number of Individuals Covered	88
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $2,719
Total amount of fees paid to insurance company	USD $3,119
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $47,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4022083

Policy instance

Insurance contract or identification number	4022083
Number of Individuals Covered	121
Insurance policy start date	2022-07-01
Insurance policy end date	2022-07-31
Total amount of commissions paid to insurance broker	USD $2,083
Total amount of fees paid to insurance company	USD $828
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30076917

Policy instance

Insurance contract or identification number	30076917
Number of Individuals Covered	64
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $583
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952518

Policy instance

Insurance contract or identification number	5952518
Number of Individuals Covered	162
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $3,821
Total amount of fees paid to insurance company	USD $1,896
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $76,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4022083

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30076917

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952518

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30076917

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30076917

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952518

Policy instance

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

10039058

Policy instance

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