401k Plan data: EARTHLINK WELFARE BENEFITS PLAN plan

EARTHLINK WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	EARTHLINK WELFARE BENEFITS PLAN
Plan identification number	501

EARTHLINK WELFARE BENEFITS 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

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

Company Name: EARTHLINK, LLC

Employer identification number (EIN): 832896224

NAIC Classification: 517000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EARTHLINK WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 SCOTT KLINGER 2024-09-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	SCOTT KLINGER	2024-09-21

Plan Statistics for EARTHLINK WELFARE BENEFITS PLAN

401k plan membership statisitcs for EARTHLINK WELFARE BENEFITS PLAN

Measure Date Value
2023: EARTHLINK WELFARE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 0
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 0
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: EARTHLINK WELFARE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	0
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	0
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for EARTHLINK WELFARE BENEFITS PLAN

2023: EARTHLINK WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )

Policy contract number

710672

Policy instance

Insurance contract or identification number	710672
Number of Individuals Covered	18
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,364
Total amount of fees paid to insurance company	USD $136
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $6,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )

Policy contract number

710671

Policy instance

Insurance contract or identification number	710671
Number of Individuals Covered	35
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,188
Total amount of fees paid to insurance company	USD $327
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $8,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

L04668

Policy instance

Insurance contract or identification number	L04668
Number of Individuals Covered	221
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $55,147
Total amount of fees paid to insurance company	USD $1,404
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,226,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )

Policy contract number

CM10001290

Policy instance

Insurance contract or identification number	CM10001290
Number of Individuals Covered	135
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,708
Total amount of fees paid to insurance company	USD $1,812
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, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $81,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	EARTHLINK, LLC
Employer identification number (EIN):	832896224
NAIC Classification:	517000