401k Plan data: INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN plan

INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN 401k Plan overview

Plan Name	INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN
Plan identification number	510

INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance) 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.

401k Sponsoring company profile

INFRASTRUCTURE ALTERNATIVES has sponsored the creation of one or more 401k plans.

Company Name: INFRASTRUCTURE ALTERNATIVES

Employer identification number (EIN): 383535922

NAIC Classification: 541330
NAIC Description: Engineering Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2021-01-01 PATRICIA BENNETT 2022-09-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
510	2021-01-01	PATRICIA BENNETT	2022-09-13

Plan Statistics for INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN

401k plan membership statisitcs for INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN

Measure Date Value
2021: INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 98
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 98
Number of employers contributing to the scheme 2021-01-01 0

Measure	Date	Value
2021: INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	98
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	98
Number of employers contributing to the scheme	2021-01-01	0

Form 5500 Responses for INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE PLAN

2021: INFRASTRUCTURE ALTERNATIVE INC.'S GROUP INSURANCE 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

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

250018

Policy instance

Insurance contract or identification number	250018
Number of Individuals Covered	20
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,908
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,050
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

250018

Policy instance

Insurance contract or identification number	250018
Number of Individuals Covered	145
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,450
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,325
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

682551

Policy instance

Insurance contract or identification number	682551
Number of Individuals Covered	80
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,152
Total amount of fees paid to insurance company	USD $114
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,240
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

EAB1000184

Policy instance

Insurance contract or identification number	EAB1000184
Number of Individuals Covered	97
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,841
Total amount of fees paid to insurance company	USD $0
Life 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 $38,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,841
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	INFRASTRUCTURE ALTERNATIVES
Employer identification number (EIN):	383535922
NAIC Classification:	541330
NAIC Description:	Engineering Services