401k Plan data: PURE SAFETY GROUP, INC MEDICAL PLAN plan

PURE SAFETY GROUP, INC MEDICAL PLAN 401k Plan overview

Plan Name	PURE SAFETY GROUP, INC MEDICAL PLAN
Plan identification number	503

PURE SAFETY GROUP, INC MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	SELECT distinct(Description) AS Description FROM 401k_benefit_codes LEFT JOIN 401k_benefit_code_description ON BenefitCode=Code COLLATE utf8_unicode_ci WHERE EIN='822198764' AND PlanID='503'

401k Sponsoring company profile

PURE SAFETY GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: PURE SAFETY GROUP, INC.

Employer identification number (EIN): 822198764

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PURE SAFETY GROUP, INC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2023-01-01 STEPHANIE MAZINGO 2024-08-20
503 2022-01-01 ANNA COTHRAN 2023-08-31

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2023-01-01	STEPHANIE MAZINGO	2024-08-20
503	2022-01-01	ANNA COTHRAN	2023-08-31

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0175890

Policy instance

Insurance contract or identification number	0175890
Number of Individuals Covered	235
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $106,030
Total amount of fees paid to insurance company	USD $172
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,497,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0175890

Policy instance

Insurance contract or identification number	0175890
Number of Individuals Covered	289
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $109,075
Total amount of fees paid to insurance company	USD $5,233
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,700,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

PURE SAFETY 401(K) PLAN [EIN = 822218072]

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Company Name:	PURE SAFETY GROUP, INC.
Employer identification number (EIN):	822198764
NAIC Classification:	339900