401k Plan data: MEDFARMS HEALTH AND WELFARE BENEFIT PLAN plan

MEDFARMS HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MEDFARMS HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

MEDFARMS HEALTH AND WELFARE BENEFIT 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)

401k Sponsoring company profile

MEDFARMS has sponsored the creation of one or more 401k plans.

Company Name: MEDFARMS

Employer identification number (EIN): 834651209

NAIC Classification: 453990

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDFARMS HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 ANDY HINDO 2024-06-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	ANDY HINDO	2024-06-17

Plan Statistics for MEDFARMS HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for MEDFARMS HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2023: MEDFARMS HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 173
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 2023-01-01 173
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: MEDFARMS HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	173
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	173
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for MEDFARMS HEALTH AND WELFARE BENEFIT PLAN

2023: MEDFARMS HEALTH AND WELFARE BENEFIT 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

10859

Policy instance

Insurance contract or identification number	10859
Number of Individuals Covered	71
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,493
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

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VEAB100253

Policy instance

Insurance contract or identification number	VEAB100253
Number of Individuals Covered	173
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $643
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7050081-0000

Policy instance

Insurance contract or identification number	7050081-0000
Number of Individuals Covered	532
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $10,045
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $170,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

612736-0001

Policy instance

Insurance contract or identification number	612736-0001
Number of Individuals Covered	29
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,925
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	MEDFARMS
Employer identification number (EIN):	834651209
NAIC Classification:	453990