401k Plan data: RESCON GROUP WELFARE BENEFIT PLAN plan

RESCON GROUP WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	RESCON GROUP WELFARE BENEFIT PLAN
Plan identification number	501

RESCON GROUP WELFARE BENEFIT 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

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

Company Name: RACI INTERMEDIATE HOLDINGS, LLC

Employer identification number (EIN): 822482495

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RESCON GROUP WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01 MAGALY TORRES 2020-07-27
501 2019-01-01 MAGALY TORRES 2021-10-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01	MAGALY TORRES	2020-07-27
501	2019-01-01	MAGALY TORRES	2021-10-07

Plan Statistics for RESCON GROUP WELFARE BENEFIT PLAN

401k plan membership statisitcs for RESCON GROUP WELFARE BENEFIT PLAN

Measure Date Value
2019: RESCON GROUP WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 237
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 2019-01-01 237
Number of employers contributing to the scheme 2019-01-01 0

Measure	Date	Value
2019: RESCON GROUP WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	237
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	237
Number of employers contributing to the scheme	2019-01-01	0

Form 5500 Responses for RESCON GROUP WELFARE BENEFIT PLAN

2019: RESCON GROUP WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	Yes
2019-01-01	This submission is the final filing	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

7S6302

Policy instance

Insurance contract or identification number	7S6302
Number of Individuals Covered	92
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $31,301
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $510,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,301
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

879734G

Policy instance

Insurance contract or identification number	879734G
Number of Individuals Covered	237
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10,995
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 $82,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,852
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	RACI INTERMEDIATE HOLDINGS, LLC
Employer identification number (EIN):	822482495
NAIC Classification:	238900