401k Plan data: INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN plan

INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN 401k Plan overview

Plan Name	INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN
Plan identification number	501

INSIGHT PA CYBER CHARTER SCHOOL 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) Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

INSIGHT PA CYBER CHARTER SCHOOL has sponsored the creation of one or more 401k plans.

Company Name: INSIGHT PA CYBER CHARTER SCHOOL

Employer identification number (EIN): 461166314

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-01-01 ANTHONY PIRRELLO 2021-08-25
501 2020-01-01 BETH JONES 2022-10-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-01-01	ANTHONY PIRRELLO	2021-08-25
501	2020-01-01	BETH JONES	2022-10-17

Plan Statistics for INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN

401k plan membership statisitcs for INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN

Measure Date Value
2020: INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 169
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 169
Number of employers contributing to the scheme 2020-01-01 0

Measure	Date	Value
2020: INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	169
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	169
Number of employers contributing to the scheme	2020-01-01	0

Form 5500 Responses for INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN

2020: INSIGHT PA CYBER CHARTER SCHOOL WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	First time form 5500 has been submitted	Yes
2020-01-01	Submission has been amended	Yes
2020-01-01	This submission is the final filing	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

2468997

Policy instance

Insurance contract or identification number	2468997
Number of Individuals Covered	279
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $39,729
Total amount of fees paid to insurance company	USD $10,435
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 $39,729
Amount paid for insurance broker fees	10435
Additional information about fees paid to insurance broker	OVERRIDE NON-MONETARY COMPENSATION
Insurance broker organization code?	3

NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 )

Policy contract number

LI8000

Policy instance

Insurance contract or identification number	LI8000
Number of Individuals Covered	242
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,319
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,449
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OVERRIDE NON-MONETARY COMPENSATION

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

Policy contract number

5956371

Policy instance

Insurance contract or identification number	5956371
Number of Individuals Covered	516
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,221
Total amount of fees paid to insurance company	USD $22
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,612
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	OVERRIDE NON-MONETARY COMPENSATION
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00618131

Policy instance

Insurance contract or identification number	G00618131
Number of Individuals Covered	146
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,780
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $38,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $3,468
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	INSIGHT PA CYBER CHARTER SCHOOL
Employer identification number (EIN):	461166314
NAIC Classification:	611000