401k Plan data: GAMECHANGE SOLAR HEALTH AND WELFARE PLAN plan

GAMECHANGE SOLAR HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	GAMECHANGE SOLAR HEALTH AND WELFARE PLAN
Plan identification number	501

GAMECHANGE SOLAR HEALTH AND WELFARE 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)
Other welfare benefit cover
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

GAMECHANGE SOLAR CORP. has sponsored the creation of one or more 401k plans.

Company Name: GAMECHANGE SOLAR CORP.

Employer identification number (EIN): 320384598

NAIC Classification: 221100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GAMECHANGE SOLAR HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 MARK GIBBENS 2024-07-03
501 2022-01-01 MARK GIBBENS 2023-06-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	MARK GIBBENS	2024-07-03
501	2022-01-01	MARK GIBBENS	2023-06-21

Form 5500 Responses for GAMECHANGE SOLAR HEALTH AND WELFARE PLAN

2023: GAMECHANGE SOLAR HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
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
2022: GAMECHANGE SOLAR HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	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

5975482

Policy instance

Insurance contract or identification number	5975482
Number of Individuals Covered	519
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $43,152
Total amount of fees paid to insurance company	USD $5,833
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $313,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

L06981

Policy instance

Insurance contract or identification number	L06981
Number of Individuals Covered	329
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $73,720
Total amount of fees paid to insurance company	USD $26,358
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,209,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

923677

Policy instance

Insurance contract or identification number	923677
Number of Individuals Covered	233
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $42,248
Total amount of fees paid to insurance company	USD $6,933
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,052,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GAMECHANGE SOLAR CORP.
Employer identification number (EIN):	320384598
NAIC Classification:	221100