401k Plan data: AGRIFY HEALTH & WELFARE PLAN plan

AGRIFY HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	AGRIFY HEALTH & WELFARE PLAN
Plan identification number	501

AGRIFY HEALTH & WELFARE 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) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

AGM SERVICE COMPANY LLC. has sponsored the creation of one or more 401k plans.

Company Name: AGM SERVICE COMPANY LLC.

Employer identification number (EIN): 851195833

NAIC Classification: 333100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AGRIFY HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-06-01 SHERYL ELLIOTT 2023-10-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-06-01	SHERYL ELLIOTT	2023-10-03

Plan Statistics for AGRIFY HEALTH & WELFARE PLAN

401k plan membership statisitcs for AGRIFY HEALTH & WELFARE PLAN

Measure Date Value
2022: AGRIFY HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 184
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 184
Number of retired or separated participants receiving benefits 2022-06-01 11
Number of other retired or separated participants entitled to future benefits 2022-06-01 2
Total of all active and inactive participants 2022-06-01 197
Number of employers contributing to the scheme 2022-06-01 0

Measure	Date	Value
2022: AGRIFY HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	184
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	184
Number of retired or separated participants receiving benefits	2022-06-01	11
Number of other retired or separated participants entitled to future benefits	2022-06-01	2
Total of all active and inactive participants	2022-06-01	197
Number of employers contributing to the scheme	2022-06-01	0

Form 5500 Responses for AGRIFY HEALTH & WELFARE PLAN

2022: AGRIFY HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	First time form 5500 has been submitted	Yes
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

953246

Policy instance

Insurance contract or identification number	953246
Number of Individuals Covered	184
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $14,426
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, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $124,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,426
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4960386

Policy instance

Insurance contract or identification number	4960386
Number of Individuals Covered	213
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $63,624
Total amount of fees paid to insurance company	USD $29,575
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $63,624
Amount paid for insurance broker fees	29575
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

40148654

Policy instance

Insurance contract or identification number	40148654
Number of Individuals Covered	100
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $1,167
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,167
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	29
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $426
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $2,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $426
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	AGM SERVICE COMPANY LLC.
Employer identification number (EIN):	851195833
NAIC Classification:	333100