401k Plan data: KUEBIX LLC WELFARE BENEFIT PLAN plan

KUEBIX LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	KUEBIX LLC WELFARE BENEFIT PLAN
Plan identification number	501

KUEBIX LLC WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: KUEBIX, LLC.

Employer identification number (EIN): 260777409

NAIC Classification: 541519
NAIC Description: Other Computer Related Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KUEBIX LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-06-01 CHRISTOPHER MARTIN 2021-12-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-06-01	CHRISTOPHER MARTIN	2021-12-17

Plan Statistics for KUEBIX LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for KUEBIX LLC WELFARE BENEFIT PLAN

Measure Date Value
2020: KUEBIX LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-06-01 246
Total number of active participants reported on line 7a of the Form 5500 2020-06-01 246
Number of retired or separated participants receiving benefits 2020-06-01 0
Number of other retired or separated participants entitled to future benefits 2020-06-01 0
Total of all active and inactive participants 2020-06-01 246
Number of employers contributing to the scheme 2020-06-01 0

Measure	Date	Value
2020: KUEBIX LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-06-01	246
Total number of active participants reported on line 7a of the Form 5500	2020-06-01	246
Number of retired or separated participants receiving benefits	2020-06-01	0
Number of other retired or separated participants entitled to future benefits	2020-06-01	0
Total of all active and inactive participants	2020-06-01	246
Number of employers contributing to the scheme	2020-06-01	0

Form 5500 Responses for KUEBIX LLC WELFARE BENEFIT PLAN

2020: KUEBIX LLC WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	First time form 5500 has been submitted	Yes
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

548990000

Policy instance

Insurance contract or identification number	548990000
Number of Individuals Covered	262
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $19,838
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,593,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,838
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

5947894

Policy instance

Insurance contract or identification number	5947894
Number of Individuals Covered	222
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $9,590
Total amount of fees paid to insurance company	USD $2,197
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,590
Amount paid for insurance broker fees	2197
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10236958

Policy instance

Insurance contract or identification number	10236958
Number of Individuals Covered	139
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $5,669
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $45,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,669
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	KUEBIX, LLC.
Employer identification number (EIN):	260777409
NAIC Classification:	541519
NAIC Description:	Other Computer Related Services