401k Plan data: IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN plan

IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN
Plan identification number	501

IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & 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)

401k Sponsoring company profile

IMPERIAL INDUSTRIES INC has sponsored the creation of one or more 401k plans.

Company Name: IMPERIAL INDUSTRIES INC

Employer identification number (EIN): 391369073

NAIC Classification: 332400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-10-01

Plan Statistics for IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

401k plan membership statisitcs for IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

Measure Date Value
2022: IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-10-01 0
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 225
Total of all active and inactive participants 2022-10-01 225
Total participants 2022-10-01 225

Measure	Date	Value
2022: IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-10-01	0
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	225
Total of all active and inactive participants	2022-10-01	225
Total participants	2022-10-01	225

Form 5500 Responses for IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

2022: IMPERIAL INDUSTRIES INC EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	First time form 5500 has been submitted	Yes
2022-10-01	Submission has been amended	No
2022-10-01	This submission is the final filing	No
2022-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-10-01	Plan is a collectively bargained plan	No
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2022-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes
2022-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )

Policy contract number

Policy instance

Number of Individuals Covered	222
Insurance policy start date	2022-10-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WYSSTA INSURANCE COMPANY INC. (National Association of Insurance Commissioners NAIC id number: 12352 )

Policy contract number

45549 00000

Policy instance

Insurance contract or identification number	45549 00000
Number of Individuals Covered	181
Insurance policy start date	2022-10-01
Insurance policy end date	2026-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $6,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

ASPIRUS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

ASP20009

Policy instance

Insurance contract or identification number	ASP20009
Number of Individuals Covered	225
Insurance policy start date	2022-10-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	IMPERIAL INDUSTRIES INC
Employer identification number (EIN):	391369073
NAIC Classification:	332400