401k Plan data: VICE MEDIA ACQUISITION, LLC BENEFIT PLAN plan

VICE MEDIA ACQUISITION, LLC BENEFIT PLAN 401k Plan overview

Plan Name	VICE MEDIA ACQUISITION, LLC BENEFIT PLAN
Plan identification number	501

VICE MEDIA ACQUISITION, LLC 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) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

VICE MEDIA ACQUISITION, LLC has sponsored the creation of one or more 401k plans.

Company Name: VICE MEDIA ACQUISITION, LLC

Employer identification number (EIN): 931995795

NAIC Classification: 515210
NAIC Description: Cable and Other Subscription Programming

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VICE MEDIA ACQUISITION, LLC BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-01-01 KIRBY REISS
501 2023-01-01 MEGAN LIVERANI 2024-09-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2024-01-01	KIRBY REISS
501	2023-01-01	MEGAN LIVERANI	2024-09-12

Form 5500 Responses for VICE MEDIA ACQUISITION, LLC BENEFIT PLAN

2023: VICE MEDIA ACQUISITION, LLC BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

30040413

Policy instance

Insurance contract or identification number	30040413
Number of Individuals Covered	408
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CORPORATE COUNSELING ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	700
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
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 $24,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

8947A

Policy instance

Insurance contract or identification number	8947A
Number of Individuals Covered	3
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

G 167889

Policy instance

Insurance contract or identification number	G 167889
Number of Individuals Covered	828
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,244
Total amount of fees paid to insurance company	USD $6,244
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $312,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	VICE MEDIA ACQUISITION, LLC
Employer identification number (EIN):	931995795
NAIC Classification:	515210
NAIC Description:	Cable and Other Subscription Programming