401k Plan data: SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN plan

SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN
Plan identification number	507

SUMARIA SYSTEMS, LLC HEALTH & WELFARE 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

SUMARIA SYSTEMS, LLC has sponsored the creation of one or more 401k plans.

Company Name: SUMARIA SYSTEMS, LLC

Employer identification number (EIN): 042770369

NAIC Classification: 541600

Additional information about SUMARIA SYSTEMS, LLC

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 2014-03-17

Company Identification Number: F195680

Legal Registered Office Address: 4701 COX RD STE 285

GLEN ALLEN
United States of America (USA)
23060-6802

More information about SUMARIA SYSTEMS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2022-01-01

Plan Statistics for SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN

401k plan membership statisitcs for SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN

Measure Date Value
2022: SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 406
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 395
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 2022-01-01 395

Measure	Date	Value
2022: SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	406
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	395
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	395

Form 5500 Responses for SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN

2022: SUMARIA SYSTEMS, LLC HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
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

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4955949

Policy instance

Insurance contract or identification number	4955949
Number of Individuals Covered	406
Insurance policy start date	2021-11-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $47,378
Total amount of fees paid to insurance company	USD $17,710
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $47,378
Amount paid for insurance broker fees	17710
Additional information about fees paid to insurance broker	OTHER COMMISSIONS
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50021049

Policy instance

Insurance contract or identification number	50021049
Number of Individuals Covered	392
Insurance policy start date	2021-11-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $70,683
Total amount of fees paid to insurance company	USD $351
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $324,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,683
Insurance broker organization code?	3
Amount paid for insurance broker fees	351
Additional information about fees paid to insurance broker	FEES PAID/ADDITIONAL COMPENSATION

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50021049

Policy instance

Insurance contract or identification number	50021049
Number of Individuals Covered	395
Insurance policy start date	2022-11-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,193
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $51,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,193
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4955949

Policy instance

Insurance contract or identification number	4955949
Number of Individuals Covered	418
Insurance policy start date	2022-11-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,653
Total amount of fees paid to insurance company	USD $13,099
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,653
Amount paid for insurance broker fees	13099
Additional information about fees paid to insurance broker	OTHER COMMISSION AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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Company Name:	SUMARIA SYSTEMS, LLC
Employer identification number (EIN):	042770369
NAIC Classification:	541600

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	2014-03-17
Company Identification Number:	F195680
Legal Registered Office Address:	4701 COX RD STE 285 GLEN ALLEN United States of America (USA) 23060-6802