401k Plan data: BLACK FOREST VENTURES, LLC plan

BLACK FOREST VENTURES, LLC 401k Plan overview

Plan Name	BLACK FOREST VENTURES, LLC
Plan identification number	501

BLACK FOREST VENTURES, LLC 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)

401k Sponsoring company profile

BLACK FOREST VENTURES, LLC has sponsored the creation of one or more 401k plans.

Company Name: BLACK FOREST VENTURES, LLC

Employer identification number (EIN): 264068540

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLACK FOREST VENTURES, LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-07-01 KATHY RHODEN 2024-12-17
501 2022-07-01 KATHY RHODEN 2023-11-07
501 2021-07-01 KATHY RHODEN 2022-11-08
501 2020-07-01 KATHY RHODEN 2021-12-01
501 2017-07-01
501 2016-07-01 KATHY RHODEN
501 2015-07-01 KATHY RHODEN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-07-01	KATHY RHODEN	2024-12-17
501	2022-07-01	KATHY RHODEN	2023-11-07
501	2021-07-01	KATHY RHODEN	2022-11-08
501	2020-07-01	KATHY RHODEN	2021-12-01
501	2017-07-01
501	2016-07-01	KATHY RHODEN
501	2015-07-01	KATHY RHODEN

Plan Statistics for BLACK FOREST VENTURES, LLC

401k plan membership statisitcs for BLACK FOREST VENTURES, LLC

Measure Date Value
2023: BLACK FOREST VENTURES, LLC 2023 401k membership
Total participants, beginning-of-year 2023-07-01 201
Total number of active participants reported on line 7a of the Form 5500 2023-07-01 196
Number of retired or separated participants receiving benefits 2023-07-01 0
Number of other retired or separated participants entitled to future benefits 2023-07-01 0
Total of all active and inactive participants 2023-07-01 196
Number of employers contributing to the scheme 2023-07-01 0
2022: BLACK FOREST VENTURES, LLC 2022 401k membership
Total participants, beginning-of-year 2022-07-01 208
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 201
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 201
Number of employers contributing to the scheme 2022-07-01 0
2021: BLACK FOREST VENTURES, LLC 2021 401k membership
Total participants, beginning-of-year 2021-07-01 196
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 208
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 208
Number of employers contributing to the scheme 2021-07-01 0
2020: BLACK FOREST VENTURES, LLC 2020 401k membership
Total participants, beginning-of-year 2020-07-01 186
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 196
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 196
Number of employers contributing to the scheme 2020-07-01 0
2017: BLACK FOREST VENTURES, LLC 2017 401k membership
Total participants, beginning-of-year 2017-07-01 445
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 465
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 0
Total of all active and inactive participants 2017-07-01 465
2016: BLACK FOREST VENTURES, LLC 2016 401k membership
Total participants, beginning-of-year 2016-07-01 222
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 188
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 188
2015: BLACK FOREST VENTURES, LLC 2015 401k membership
Total participants, beginning-of-year 2015-07-01 209
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 209
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 209

Measure	Date	Value
2023: BLACK FOREST VENTURES, LLC 2023 401k membership
Total participants, beginning-of-year	2023-07-01	201
Total number of active participants reported on line 7a of the Form 5500	2023-07-01	196
Number of retired or separated participants receiving benefits	2023-07-01	0
Number of other retired or separated participants entitled to future benefits	2023-07-01	0
Total of all active and inactive participants	2023-07-01	196
Number of employers contributing to the scheme	2023-07-01	0
2022: BLACK FOREST VENTURES, LLC 2022 401k membership
Total participants, beginning-of-year	2022-07-01	208
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	201
Number of retired or separated participants receiving benefits	2022-07-01	0
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	201
Number of employers contributing to the scheme	2022-07-01	0
2021: BLACK FOREST VENTURES, LLC 2021 401k membership
Total participants, beginning-of-year	2021-07-01	196
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	208
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	208
Number of employers contributing to the scheme	2021-07-01	0
2020: BLACK FOREST VENTURES, LLC 2020 401k membership
Total participants, beginning-of-year	2020-07-01	186
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	196
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	196
Number of employers contributing to the scheme	2020-07-01	0
2017: BLACK FOREST VENTURES, LLC 2017 401k membership
Total participants, beginning-of-year	2017-07-01	445
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	465
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	465
2016: BLACK FOREST VENTURES, LLC 2016 401k membership
Total participants, beginning-of-year	2016-07-01	222
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	188
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	188
2015: BLACK FOREST VENTURES, LLC 2015 401k membership
Total participants, beginning-of-year	2015-07-01	209
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	209
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	209

Form 5500 Responses for BLACK FOREST VENTURES, LLC

2023: BLACK FOREST VENTURES, LLC 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: BLACK FOREST VENTURES, LLC 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
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
2021: BLACK FOREST VENTURES, LLC 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: BLACK FOREST VENTURES, LLC 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: BLACK FOREST VENTURES, LLC 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: BLACK FOREST VENTURES, LLC 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: BLACK FOREST VENTURES, LLC 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	First time form 5500 has been submitted	Yes
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

921236G

Policy instance

Insurance contract or identification number	921236G
Number of Individuals Covered	200
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $36,973
Total amount of fees paid to insurance company	USD $16,043
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 $250,231
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-062167

Policy instance

Insurance contract or identification number	010-062167
Number of Individuals Covered	580
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $21,942
Total amount of fees paid to insurance company	USD $2,026
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BKD5

Policy instance

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

953640

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BKD5

Policy instance

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

Policy contract number

KM05959083

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10010921001

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BKD5

Policy instance

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

Policy contract number

KM05959083

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10010921001

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0B6XC

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

1001092

Policy instance

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5476748

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

1001092

Policy instance

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

Policy contract number

905375

Policy instance

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5476748

Policy instance

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Company Name:	BLACK FOREST VENTURES, LLC
Employer identification number (EIN):	264068540
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies