401k Plan data: XL COMPANIES LLC HEALTH AND WELFARE PLAN plan

XL COMPANIES LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	XL COMPANIES LLC HEALTH AND WELFARE PLAN
Plan identification number	501

XL COMPANIES LLC HEALTH AND WELFARE 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) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: XL COMPANIES

Employer identification number (EIN): 844187562

NAIC Classification: 236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan XL COMPANIES LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-03-01 KELLEY ROBLES 2021-09-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-03-01	KELLEY ROBLES	2021-09-28

Plan Statistics for XL COMPANIES LLC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for XL COMPANIES LLC HEALTH AND WELFARE PLAN

Measure Date Value
2020: XL COMPANIES LLC HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-03-01 580
Total number of active participants reported on line 7a of the Form 5500 2020-03-01 580
Number of retired or separated participants receiving benefits 2020-03-01 0
Number of other retired or separated participants entitled to future benefits 2020-03-01 0
Total of all active and inactive participants 2020-03-01 580
Number of employers contributing to the scheme 2020-03-01 0

Measure	Date	Value
2020: XL COMPANIES LLC HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-03-01	580
Total number of active participants reported on line 7a of the Form 5500	2020-03-01	580
Number of retired or separated participants receiving benefits	2020-03-01	0
Number of other retired or separated participants entitled to future benefits	2020-03-01	0
Total of all active and inactive participants	2020-03-01	580
Number of employers contributing to the scheme	2020-03-01	0

Form 5500 Responses for XL COMPANIES LLC HEALTH AND WELFARE PLAN

2020: XL COMPANIES LLC HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-03-01	Type of plan entity	Single employer plan
2020-03-01	First time form 5500 has been submitted	Yes
2020-03-01	Plan funding arrangement – Insurance	Yes
2020-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

198927

Policy instance

Insurance contract or identification number	198927
Number of Individuals Covered	580
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $1,306
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $31,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,306
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )

Policy contract number

198927

Policy instance

Insurance contract or identification number	198927
Number of Individuals Covered	341
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $44,286
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 $1,067,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,286
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

XL COMPANIES 401(K) RETIREMENT PLAN [EIN = 844197562]

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Company Name:	XL COMPANIES
Employer identification number (EIN):	844187562
NAIC Classification:	236110