EMPOWER LGA, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYER LGA WELFARE BENEFIT PLAN
| 2023: EMPLOYER LGA WELFARE BENEFIT PLAN 2023 form 5500 responses |
|---|
| 2023-07-01 | Type of plan entity | Single employer plan |
| 2023-07-01 | Plan funding arrangement – Insurance | Yes |
| 2023-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: EMPLOYER LGA WELFARE 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 funding arrangement – General assets of the sponsor | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10069631001 |
| Policy instance | 5 |
| Insurance contract or identification number | 10069631001 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-06-30 | | Total amount of commissions paid to insurance broker | USD $537 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4960436 |
| Policy instance | 4 |
| Insurance contract or identification number | 4960436 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-06-30 | | Total amount of commissions paid to insurance broker | USD $3,552 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 013277 |
| Policy instance | 3 |
| Insurance contract or identification number | 013277 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-06-30 | | Total amount of commissions paid to insurance broker | USD $1,773 | | Total amount of fees paid to insurance company | USD $891 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,824 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 013277 |
| Policy instance | 2 |
| Insurance contract or identification number | 013277 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-06-30 | | Total amount of commissions paid to insurance broker | USD $2,920 | | Total amount of fees paid to insurance company | USD $1,519 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 02Q5058 |
| Policy instance | 1 |
| Insurance contract or identification number | 02Q5058 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-06-30 | | Total amount of commissions paid to insurance broker | USD $27,229 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $907,629 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10069631001 |
| Policy instance | 5 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4960436 |
| Policy instance | 4 |
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 013277 |
| Policy instance | 3 |
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 013277 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 02Q5058 |
| Policy instance | 1 |
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