401k Plan data: AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE PLAN plan

AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE PLAN 401k Plan overview

Plan Name	AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE PLAN
Plan identification number	501

AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE 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) Other welfare benefit cover

401k Sponsoring company profile

AMERICAN TECHNOLOGY COMPONENTS, INC . has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN TECHNOLOGY COMPONENTS, INC .

Employer identification number (EIN): 351688483

NAIC Classification: 423100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 JORDAN HESTERS 2024-07-22
501 2022-01-01 JORDAN HESTERS 2023-07-27
501 2021-01-01 JORDAN HESTERS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	JORDAN HESTERS	2024-07-22
501	2022-01-01	JORDAN HESTERS	2023-07-27
501	2021-01-01	JORDAN HESTERS

Form 5500 Responses for AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE PLAN

2023: AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE 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 benefit arrangement – Insurance	Yes
2022: AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: AMERICAN TECHNOLOGY COMPONENTS, INC. EMPLOYEE HEALTH CARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0764700000

Policy instance

Insurance contract or identification number	0764700000
Number of Individuals Covered	24
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $11,820
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

955539

Policy instance

Insurance contract or identification number	955539
Number of Individuals Covered	179
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $22,129
Total amount of fees paid to insurance company	USD $1,916
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $58,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SIRIUS AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 35408 )

Policy contract number

A1061

Policy instance

Insurance contract or identification number	A1061
Number of Individuals Covered	96
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $17,844
Total amount of fees paid to insurance company	USD $33,720
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05934741

Policy instance

Insurance contract or identification number	KM05934741
Number of Individuals Covered	284
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,846
Total amount of fees paid to insurance company	USD $56
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $25,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

0429201132AM

Policy instance

Insurance contract or identification number	0429201132AM
Number of Individuals Covered	86
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,556
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

361389341320

Policy instance

Insurance contract or identification number	361389341320
Number of Individuals Covered	84
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,444
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SIRIUS AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 35408 )

Policy contract number

A1061

Policy instance

Insurance contract or identification number	A1061
Number of Individuals Covered	45
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $18,030
Total amount of fees paid to insurance company	USD $38,310
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

Y4372

Policy instance

Insurance contract or identification number	Y4372
Number of Individuals Covered	29
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,159
Total amount of fees paid to insurance company	USD $763
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

M1W13

Policy instance

Insurance contract or identification number	M1W13
Number of Individuals Covered	51
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $12,322
Total amount of fees paid to insurance company	USD $372
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05934741

Policy instance

Insurance contract or identification number	KM05934741
Number of Individuals Covered	299
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,522
Total amount of fees paid to insurance company	USD $63
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $31,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

0429201132AM

Policy instance

Insurance contract or identification number	0429201132AM
Number of Individuals Covered	102
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,283
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

361389341320

Policy instance

Insurance contract or identification number	361389341320
Number of Individuals Covered	80
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,345
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SIRIUS AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 35408 )

Policy contract number

A1061

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

Y4372

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

M1W13

Policy instance

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

Policy contract number

KM05934741

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

0429201132AM

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

361389341320

Policy instance

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Company Name:	AMERICAN TECHNOLOGY COMPONENTS, INC .
Employer identification number (EIN):	351688483
NAIC Classification:	423100