401k Plan data: THE COLLINS GROUP HEALTH PLAN plan

THE COLLINS GROUP HEALTH PLAN 401k Plan overview

Plan Name	THE COLLINS GROUP HEALTH PLAN
Plan identification number	502

THE COLLINS GROUP HEALTH PLAN 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

THE COLLINS GROUP INC. has sponsored the creation of one or more 401k plans.

Company Name: THE COLLINS GROUP INC.

Employer identification number (EIN): 351514569

NAIC Classification: 517000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE COLLINS GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-09-01 DEBBIE VORIS 2023-04-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-09-01	DEBBIE VORIS	2023-04-24

Plan Statistics for THE COLLINS GROUP HEALTH PLAN

401k plan membership statisitcs for THE COLLINS GROUP HEALTH PLAN

Measure Date Value
2021: THE COLLINS GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year 2021-09-01 167
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 182
Number of retired or separated participants receiving benefits 2021-09-01 0
Number of other retired or separated participants entitled to future benefits 2021-09-01 0
Total of all active and inactive participants 2021-09-01 182
Number of employers contributing to the scheme 2021-09-01 0

Measure	Date	Value
2021: THE COLLINS GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-01	167
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	182
Number of retired or separated participants receiving benefits	2021-09-01	0
Number of other retired or separated participants entitled to future benefits	2021-09-01	0
Total of all active and inactive participants	2021-09-01	182
Number of employers contributing to the scheme	2021-09-01	0

Form 5500 Responses for THE COLLINS GROUP HEALTH PLAN

2021: THE COLLINS GROUP HEALTH PLAN 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	First time form 5500 has been submitted	Yes
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L00887

Policy instance

Insurance contract or identification number	L00887
Number of Individuals Covered	89
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $21,866
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $539,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $21,866
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

563569

Policy instance

Insurance contract or identification number	563569
Number of Individuals Covered	86
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $4,907
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $4,866
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

428311

Policy instance

Insurance contract or identification number	428311
Number of Individuals Covered	182
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $1,986
Total amount of fees paid to insurance company	USD $488
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	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 $14,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,986
Amount paid for insurance broker fees	488
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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Company Name:	THE COLLINS GROUP INC.
Employer identification number (EIN):	351514569
NAIC Classification:	517000