401k Plan data: FOSS SWIM SCHOOLS GROUP BENEFITS WRAP DOCUMENT plan

FOSS SWIM SCHOOLS GROUP BENEFITS WRAP DOCUMENT 401k Plan overview

Plan Name	FOSS SWIM SCHOOLS GROUP BENEFITS WRAP DOCUMENT
Plan identification number	501

FOSS SWIM SCHOOLS GROUP BENEFITS WRAP DOCUMENT 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

FOSS SWIM SCHOOL, LLC has sponsored the creation of one or more 401k plans.

Company Name: FOSS SWIM SCHOOL, LLC

Employer identification number (EIN): 272224351

NAIC Classification: 713900

Additional information about FOSS SWIM SCHOOL, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4804435

More information about FOSS SWIM SCHOOL, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOSS SWIM SCHOOLS GROUP BENEFITS WRAP DOCUMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 LETHA KUNSHIER 2024-10-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	LETHA KUNSHIER	2024-10-03

Form 5500 Responses for FOSS SWIM SCHOOLS GROUP BENEFITS WRAP DOCUMENT

2023: FOSS SWIM SCHOOLS GROUP BENEFITS WRAP DOCUMENT 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

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E4593000

Policy instance

Insurance contract or identification number	E4593000
Number of Individuals Covered	15
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,013
Total amount of fees paid to insurance company	USD $765
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE,DISABILTY
Welfare Benefit Premiums Paid to Carrier	USD $9,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E4575254

Policy instance

Insurance contract or identification number	E4575254
Number of Individuals Covered	6
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $277
Total amount of fees paid to insurance company	USD $128
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE,DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $1,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E4575262

Policy instance

Insurance contract or identification number	E4575262
Number of Individuals Covered	8
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,650
Total amount of fees paid to insurance company	USD $839
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE,DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5127782

Policy instance

Insurance contract or identification number	E5127782
Number of Individuals Covered	1
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $169
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE,DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $1,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5375357

Policy instance

Insurance contract or identification number	E5375357
Number of Individuals Covered	1
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $389
Total amount of fees paid to insurance company	USD $142
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE,DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $1,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5384300

Policy instance

Insurance contract or identification number	E5384300
Number of Individuals Covered	0
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $284
Total amount of fees paid to insurance company	USD $155
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, MEDICAL BRIDGE,DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

919809

Policy instance

Insurance contract or identification number	919809
Number of Individuals Covered	158
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,311
Total amount of fees paid to insurance company	USD $1,675
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $852,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FOSS SWIM SCHOOL, LLC
Employer identification number (EIN):	272224351
NAIC Classification:	713900

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4804435