401k Plan data: SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN plan

SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN 401k Plan overview

Plan Name	SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN
Plan identification number	505

SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Other welfare benefit cover

401k Sponsoring company profile

SANY AMERICA, INC. has sponsored the creation of one or more 401k plans.

Company Name: SANY AMERICA, INC.

Employer identification number (EIN): 205048542

NAIC Classification: 333200

Additional information about SANY AMERICA, INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4171378

More information about SANY AMERICA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2022-01-01 SCOTT BECK 2023-10-10
505 2021-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2022-01-01	SCOTT BECK	2023-10-10
505	2021-01-01

Plan Statistics for SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN

401k plan membership statisitcs for SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN

Measure Date Value
2022: SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 304
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 207
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 2022-01-01 207
Number of employers contributing to the scheme 2022-01-01 0
2021: SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 304
Total of all active and inactive participants 2021-01-01 304

Measure	Date	Value
2022: SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	304
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	207
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	207
Number of employers contributing to the scheme	2022-01-01	0
2021: SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	304
Total of all active and inactive participants	2021-01-01	304

Form 5500 Responses for SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN

2022: SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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
2021: SANY AMERICA, INC. MEDICAL DENTAL VISION PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

539283

Policy instance

Insurance contract or identification number	539283
Number of Individuals Covered	488
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $25,534
Total amount of fees paid to insurance company	USD $4,738
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM,ACCIDENT,CRITICAL ILLNESS,HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $212,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,716
Amount paid for insurance broker fees	124
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0921120

Policy instance

Insurance contract or identification number	0921120
Number of Individuals Covered	4
Insurance policy start date	2012-04-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,634
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,335
Commission paid to Insurance Broker	USD $1,634
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8907

Policy instance

Insurance contract or identification number	GA8907
Number of Individuals Covered	681
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $65,969
Total amount of fees paid to insurance company	USD $7,145
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $512,249
Commission paid to Insurance Broker	USD $65,969
Amount paid for insurance broker fees	7145
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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Company Name:	SANY AMERICA, INC.
Employer identification number (EIN):	205048542
NAIC Classification:	333200

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4171378