401k Plan data: HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN plan

HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	506

HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT 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)

401k Sponsoring company profile

HEALTHSMART BENEFITS MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name: HEALTHSMART BENEFITS MANAGEMENT, LLC

Employer identification number (EIN): 271504892

NAIC Classification: 524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2019-01-01 VICKI STROUT 2020-09-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
506	2019-01-01	VICKI STROUT	2020-09-09

Plan Statistics for HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2019: HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 740
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 799
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 799
Number of employers contributing to the scheme 2019-01-01 0

Measure	Date	Value
2019: HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	740
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	799
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	799
Number of employers contributing to the scheme	2019-01-01	0

Form 5500 Responses for HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN

2019: HEALTHSMART HOLDINGS, INC. EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30015923

Policy instance

Insurance contract or identification number	30015923
Number of Individuals Covered	620
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3338655

Policy instance

Insurance contract or identification number	3338655
Number of Individuals Covered	570
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $387,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966548

Policy instance

Insurance contract or identification number	FLX966548
Number of Individuals Covered	799
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $23,037
Total amount of fees paid to insurance company	USD $6,062
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	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT,CRITICAL ILLNESS,HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $373,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,037
Amount paid for insurance broker fees	6062
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

Potentially related plans

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Company Name:	HEALTHSMART BENEFITS MANAGEMENT, LLC
Employer identification number (EIN):	271504892
NAIC Classification:	524290