401k Plan data: TIS INTERNATIONAL USA, INC. HEALTH & WELFARE PLAN plan

TIS INTERNATIONAL USA, INC. HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	TIS INTERNATIONAL USA, INC. HEALTH & WELFARE PLAN
Plan identification number	501

TIS INTERNATIONAL USA, INC. 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

TIS INTERNATIONAL INC has sponsored the creation of one or more 401k plans.

Company Name: TIS INTERNATIONAL INC

Employer identification number (EIN): 204960172

NAIC Classification: 551112
NAIC Description: Offices of Other Holding Companies

Additional information about TIS INTERNATIONAL INC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5068157

More information about TIS INTERNATIONAL INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TIS INTERNATIONAL USA, INC. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 DIANA DEAN 2024-10-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	DIANA DEAN	2024-10-04

Form 5500 Responses for TIS INTERNATIONAL USA, INC. HEALTH & WELFARE PLAN

2023: TIS INTERNATIONAL USA, INC. HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

717648

Policy instance

Insurance contract or identification number	717648
Number of Individuals Covered	10
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,000
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,297
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

10516

Policy instance

Insurance contract or identification number	10516
Number of Individuals Covered	221
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $24,121
Total amount of fees paid to insurance company	USD $4,928
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $120,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5383939

Policy instance

Insurance contract or identification number	5383939
Number of Individuals Covered	505
Insurance policy start date	2023-05-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $39,942
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM,CRITICAL ILLNESS,HOSPITAL,ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $267,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TIS INTERNATIONAL INC
Employer identification number (EIN):	204960172
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5068157