401k Plan data: ATLAS VINEYARD MANAGEMENT plan

ATLAS VINEYARD MANAGEMENT 401k Plan overview

Plan Name	ATLAS VINEYARD MANAGEMENT
Plan identification number	501

ATLAS VINEYARD MANAGEMENT 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

ATLAS VINEYARD MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name: ATLAS VINEYARD MANAGEMENT, LLC

Employer identification number (EIN): 870883500

NAIC Classification: 312130
NAIC Description: Wineries

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ATLAS VINEYARD MANAGEMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-03-01 MATT BELLI 2024-08-21
501 2022-03-01 MATT BELLI 2024-05-03
501 2021-03-01 MATT BELLI 2024-05-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-03-01	MATT BELLI	2024-08-21
501	2022-03-01	MATT BELLI	2024-05-03
501	2021-03-01	MATT BELLI	2024-05-03

Form 5500 Responses for ATLAS VINEYARD MANAGEMENT

2023: ATLAS VINEYARD MANAGEMENT 2023 form 5500 responses
2023-03-01	Type of plan entity	Single employer plan
2023-03-01	Plan funding arrangement – Insurance	Yes
2023-03-01	Plan benefit arrangement – Insurance	Yes
2022: ATLAS VINEYARD MANAGEMENT 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Submission has been amended	Yes
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes
2021: ATLAS VINEYARD MANAGEMENT 2021 form 5500 responses
2021-03-01	Type of plan entity	Single employer plan
2021-03-01	Submission has been amended	Yes
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0C3T8

Policy instance

Insurance contract or identification number	GLUG0C3T8
Number of Individuals Covered	317
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $24,979
Total amount of fees paid to insurance company	USD $7,182
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $249,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

930952

Policy instance

Insurance contract or identification number	930952
Number of Individuals Covered	180
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $54,810
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,096,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

603836

Policy instance

Insurance contract or identification number	603836
Number of Individuals Covered	102
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $37,656
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $761,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

ER00024470

Policy instance

Insurance contract or identification number	ER00024470
Number of Individuals Covered	50
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $8,355
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $17,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

22561

Policy instance

Insurance contract or identification number	22561
Number of Individuals Covered	34
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $9,310
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $198,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

22561

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0C3T8

Policy instance

WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95019 )

Policy contract number

950430

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

603836

Policy instance

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

ER00024470

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

613238

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

603836

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

408684

Policy instance

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

ER00024470

Policy instance

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

22561

Policy instance

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Company Name:	ATLAS VINEYARD MANAGEMENT, LLC
Employer identification number (EIN):	870883500
NAIC Classification:	312130
NAIC Description:	Wineries