401k Plan data: IMMUTA INC HEALTH & WELFARE PLAN plan

IMMUTA INC HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	IMMUTA INC HEALTH & WELFARE PLAN
Plan identification number	501

IMMUTA INC HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

IMMUTA, INC. has sponsored the creation of one or more 401k plans.

Company Name: IMMUTA, INC.

Employer identification number (EIN): 471877648

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IMMUTA INC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-11-01
501 2020-11-01 JANET CARLSON 2022-05-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-11-01
501	2020-11-01	JANET CARLSON	2022-05-19

Plan Statistics for IMMUTA INC HEALTH & WELFARE PLAN

401k plan membership statisitcs for IMMUTA INC HEALTH & WELFARE PLAN

Measure Date Value
2021: IMMUTA INC HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-11-01 192
Total number of active participants reported on line 7a of the Form 5500 2021-11-01 0
Number of retired or separated participants receiving benefits 2021-11-01 0
Number of other retired or separated participants entitled to future benefits 2021-11-01 0
Total of all active and inactive participants 2021-11-01 0
2020: IMMUTA INC HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-11-01 108
Total number of active participants reported on line 7a of the Form 5500 2020-11-01 191
Number of retired or separated participants receiving benefits 2020-11-01 1
Number of other retired or separated participants entitled to future benefits 2020-11-01 0
Total of all active and inactive participants 2020-11-01 192
Number of employers contributing to the scheme 2020-11-01 0

Measure	Date	Value
2021: IMMUTA INC HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-11-01	192
Total number of active participants reported on line 7a of the Form 5500	2021-11-01	0
Number of retired or separated participants receiving benefits	2021-11-01	0
Number of other retired or separated participants entitled to future benefits	2021-11-01	0
Total of all active and inactive participants	2021-11-01	0
2020: IMMUTA INC HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-11-01	108
Total number of active participants reported on line 7a of the Form 5500	2020-11-01	191
Number of retired or separated participants receiving benefits	2020-11-01	1
Number of other retired or separated participants entitled to future benefits	2020-11-01	0
Total of all active and inactive participants	2020-11-01	192
Number of employers contributing to the scheme	2020-11-01	0

Form 5500 Responses for IMMUTA INC HEALTH & WELFARE PLAN

2021: IMMUTA INC HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-11-01	Type of plan entity	Single employer plan
2021-11-01	Submission has been amended	No
2021-11-01	This submission is the final filing	Yes
2021-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-11-01	Plan is a collectively bargained plan	No
2021-11-01	Plan funding arrangement – Insurance	Yes
2021-11-01	Plan benefit arrangement – Insurance	Yes
2020: IMMUTA INC HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-11-01	Type of plan entity	Single employer plan
2020-11-01	First time form 5500 has been submitted	Yes
2020-11-01	Plan funding arrangement – Insurance	Yes
2020-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )

Policy contract number

1VML

Policy instance

Insurance contract or identification number	1VML
Number of Individuals Covered	629
Insurance policy start date	2021-11-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $10,458
Total amount of fees paid to insurance company	USD $173,476
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	Yes
Vision Insurance Welfare Benefit	Yes
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 $3,584,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,458
Amount paid for insurance broker fees	162205
Additional information about fees paid to insurance broker	BONUS, PRODUCER SERVICE FEE
Insurance broker organization code?	3

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

1VML

Policy instance

Insurance contract or identification number	1VML
Number of Individuals Covered	481
Insurance policy start date	2020-11-01
Insurance policy end date	2021-10-31
Total amount of commissions paid to insurance broker	USD $7,362
Total amount of fees paid to insurance company	USD $95,452
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,795,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,362
Amount paid for insurance broker fees	87284
Additional information about fees paid to insurance broker	PERSISTENCY BONUS, PRODUCER SERVICE FEE
Insurance broker organization code?	3

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Company Name:	IMMUTA, INC.
Employer identification number (EIN):	471877648
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services