401k Plan data: THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN plan

THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN 401k Plan overview

Plan Name	THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN
Plan identification number	513

THE OPPORTUNITY ALLIANCE WRAP 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)

401k Sponsoring company profile

THE OPPORTUNITY ALLIANCE has sponsored the creation of one or more 401k plans.

Company Name: THE OPPORTUNITY ALLIANCE

Employer identification number (EIN): 010274725

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
513 2022-07-01 JOSEPH EVERETT 2023-12-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
513	2022-07-01	JOSEPH EVERETT	2023-12-13

Plan Statistics for THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN

401k plan membership statisitcs for THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN

Measure Date Value
2022: THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 338
Number of retired or separated participants receiving benefits 2022-07-01 1
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 339
Number of employers contributing to the scheme 2022-07-01 0

Measure	Date	Value
2022: THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	338
Number of retired or separated participants receiving benefits	2022-07-01	1
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	339
Number of employers contributing to the scheme	2022-07-01	0

Form 5500 Responses for THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN

2022: THE OPPORTUNITY ALLIANCE WRAP BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	First time form 5500 has been submitted	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

97123991001

Policy instance

Insurance contract or identification number	97123991001
Number of Individuals Covered	685
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,363
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,363
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL PLAN OF MAINE (National Association of Insurance Commissioners NAIC id number: 14369 )

Policy contract number

61909

Policy instance

Insurance contract or identification number	61909
Number of Individuals Covered	497
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $8,652
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 $8,459
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

575206

Policy instance

Insurance contract or identification number	575206
Number of Individuals Covered	338
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $30,198
Total amount of fees paid to insurance company	USD $7,680
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
Welfare Benefit Premiums Paid to Carrier	USD $237,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,936
Amount paid for insurance broker fees	7680
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

074873

Policy instance

Insurance contract or identification number	074873
Number of Individuals Covered	426
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $74,692
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,265,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $74,692
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

074874

Policy instance

Insurance contract or identification number	074874
Number of Individuals Covered	31
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $5,903
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $221,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $5,903
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

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Company Name:	THE OPPORTUNITY ALLIANCE
Employer identification number (EIN):	010274725
NAIC Classification:	624100
NAIC Description:	Individual and Family Services