401k Plan data: EMT INTERNATIONAL WRAP PLAN plan

EMT INTERNATIONAL WRAP PLAN 401k Plan overview

Plan Name	EMT INTERNATIONAL WRAP PLAN
Plan identification number	510

EMT INTERNATIONAL WRAP 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

EMTRO, LLC DBA EMT INTERNATIONAL has sponsored the creation of one or more 401k plans.

Company Name: EMTRO, LLC DBA EMT INTERNATIONAL

Employer identification number (EIN): 880616580

NAIC Classification: 333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMT INTERNATIONAL WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2022-01-01

Plan Statistics for EMT INTERNATIONAL WRAP PLAN

401k plan membership statisitcs for EMT INTERNATIONAL WRAP PLAN

Measure Date Value
2022: EMT INTERNATIONAL WRAP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 134
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 134

Measure	Date	Value
2022: EMT INTERNATIONAL WRAP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	134
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	134

Form 5500 Responses for EMT INTERNATIONAL WRAP PLAN

2022: EMT INTERNATIONAL WRAP PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )

Policy contract number

03214

Policy instance

Insurance contract or identification number	03214
Number of Individuals Covered	90
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,938
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,938
Insurance broker organization code?	3

WYSSTA INSURANCE COMPANY INC. (National Association of Insurance Commissioners NAIC id number: 12352 )

Policy contract number

43377

Policy instance

Insurance contract or identification number	43377
Number of Individuals Covered	87
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $774
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $774
Insurance broker organization code?	3

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

16ENELA

Policy instance

Insurance contract or identification number	16ENELA
Number of Individuals Covered	257
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $26,780
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,085,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,780
Insurance broker organization code?	3

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

Policy contract number

00534319

Policy instance

Insurance contract or identification number	00534319
Number of Individuals Covered	137
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,642
Total amount of fees paid to insurance company	USD $3,673
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, CRITICAL ILLNESS, HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $118,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,951
Insurance broker organization code?	3
Amount paid for insurance broker fees	3673
Additional information about fees paid to insurance broker	FEES

Potentially related plans

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Company Name:	EMTRO, LLC DBA EMT INTERNATIONAL
Employer identification number (EIN):	880616580
NAIC Classification:	333200