401k Plan data: 212 MANAGEMENT SERVICES INC. plan

212 MANAGEMENT SERVICES INC. 401k Plan overview

Plan Name	212 MANAGEMENT SERVICES INC.
Plan identification number	501

212 MANAGEMENT SERVICES INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

212 MANAGEMENT SERVICES has sponsored the creation of one or more 401k plans.

Company Name: 212 MANAGEMENT SERVICES

Employer identification number (EIN): 851677076

NAIC Classification: 112111
NAIC Description: Beef Cattle Ranching and Farming

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 212 MANAGEMENT SERVICES INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-11-01

Plan Statistics for 212 MANAGEMENT SERVICES INC.

401k plan membership statisitcs for 212 MANAGEMENT SERVICES INC.

Measure Date Value
2022: 212 MANAGEMENT SERVICES INC. 2022 401k membership
Total participants, beginning-of-year 2022-01-01 178
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 141
Total of all active and inactive participants 2022-01-01 141
Total participants 2022-01-01 141
2021: 212 MANAGEMENT SERVICES INC. 2021 401k membership
Total participants, beginning-of-year 2021-11-01 191
Total number of active participants reported on line 7a of the Form 5500 2021-11-01 178
Total of all active and inactive participants 2021-11-01 178
Total participants 2021-11-01 178

Measure	Date	Value
2022: 212 MANAGEMENT SERVICES INC. 2022 401k membership
Total participants, beginning-of-year	2022-01-01	178
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	141
Total of all active and inactive participants	2022-01-01	141
Total participants	2022-01-01	141
2021: 212 MANAGEMENT SERVICES INC. 2021 401k membership
Total participants, beginning-of-year	2021-11-01	191
Total number of active participants reported on line 7a of the Form 5500	2021-11-01	178
Total of all active and inactive participants	2021-11-01	178
Total participants	2021-11-01	178

Form 5500 Responses for 212 MANAGEMENT SERVICES INC.

2022: 212 MANAGEMENT SERVICES INC. 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: 212 MANAGEMENT SERVICES INC. 2021 form 5500 responses
2021-11-01	Type of plan entity	Single employer plan
2021-11-01	Submission has been amended	No
2021-11-01	This submission is the final filing	No
2021-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-11-01	Plan is a collectively bargained plan	No
2021-11-01	Plan funding arrangement – Insurance	Yes
2021-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )

Policy contract number

10542653

Policy instance

Insurance contract or identification number	10542653
Number of Individuals Covered	141
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $39,136
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,136

BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )

Policy contract number

271023

Policy instance

Insurance contract or identification number	271023
Number of Individuals Covered	174
Insurance policy start date	2021-11-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $9,293
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $219,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,292

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Company Name:	212 MANAGEMENT SERVICES
Employer identification number (EIN):	851677076
NAIC Classification:	112111
NAIC Description:	Beef Cattle Ranching and Farming