401k Plan data: I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN plan

I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

I AM BOUNDLESS HEALTH AND WELFARE BENEFIT 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

I AM BOUNDLESS, INC. has sponsored the creation of one or more 401k plans.

Company Name: I AM BOUNDLESS, INC.

Employer identification number (EIN): 900817260

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-07-01 CHRIS WOLF 2024-11-11
501 2022-07-01 CHRIS WOLF 2024-01-10
501 2021-07-01 CHRIS WOLF 2022-12-12
501 2021-04-01 CHRIS WOLF 2021-11-22
501 2020-04-01 CHRIS WOLF 2021-10-14
501 2019-04-01 MATT HOBBS 2020-10-14
501 2018-04-01 MATT HOBBS 2020-01-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-07-01	CHRIS WOLF	2024-11-11
501	2022-07-01	CHRIS WOLF	2024-01-10
501	2021-07-01	CHRIS WOLF	2022-12-12
501	2021-04-01	CHRIS WOLF	2021-11-22
501	2020-04-01	CHRIS WOLF	2021-10-14
501	2019-04-01	MATT HOBBS	2020-10-14
501	2018-04-01	MATT HOBBS	2020-01-15

Form 5500 Responses for I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN

2023: I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Submission has been amended	No
2019-04-01	This submission is the final filing	No
2019-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-04-01	Plan is a collectively bargained plan	No
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: I AM BOUNDLESS HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Submission has been amended	No
2018-04-01	This submission is the final filing	No
2018-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-04-01	Plan is a collectively bargained plan	No
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

147398

Policy instance

Insurance contract or identification number	147398
Number of Individuals Covered	99
Insurance policy start date	2023-09-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $1,253
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $6,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

147398

Policy instance

Insurance contract or identification number	147398
Number of Individuals Covered	71
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $2,136
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $9,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

BOUNDLESS

Policy instance

Insurance contract or identification number	BOUNDLESS
Number of Individuals Covered	3034
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $54,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

35992

Policy instance

Insurance contract or identification number	35992
Number of Individuals Covered	1007
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $74,500
Total amount of fees paid to insurance company	USD $22,850
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $720,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM4599/BEC4600

Policy instance

Insurance contract or identification number	BCM4599/BEC4600
Number of Individuals Covered	43
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $7,291
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM4599/BEC4600

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

K5B73

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

35992

Policy instance

COMPSYCH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

BOUNDLESS

Policy instance

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

147398

Policy instance

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Z6G-001 002

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM004599

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

K5B73

Policy instance

MATRIX (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Z6G-001 002

Policy instance

MATRIX (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

167435

Policy instance

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

167435

Policy instance

MATRIX (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

82-2723296

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM4599/BEC46

Policy instance

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Z6G-001 002

Policy instance

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Z6G-001 002

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM4599/BEC4600

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

K5B73

Policy instance

MATRIX (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

167435

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

000

Policy instance

THP INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60016 )

Policy contract number

000

Policy instance

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

Policy contract number

30041716

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5951324

Policy instance

WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )

Policy contract number

ESL1000540 01

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5951324

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM004599

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5951324

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5951324

Policy instance

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Company Name:	I AM BOUNDLESS, INC.
Employer identification number (EIN):	900817260
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)