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	502

IMMUTA INC HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

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
502 2021-12-01
502 2020-12-01 JANET CARLSON 2022-05-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-12-01
502	2020-12-01	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 2021-12-01 196
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 242
Number of retired or separated participants receiving benefits 2021-12-01 0
Number of other retired or separated participants entitled to future benefits 2021-12-01 0
Total of all active and inactive participants 2021-12-01 242
2020: IMMUTA INC HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-12-01 110
Total number of active participants reported on line 7a of the Form 5500 2020-12-01 196
Number of retired or separated participants receiving benefits 2020-12-01 0
Number of other retired or separated participants entitled to future benefits 2020-12-01 0
Total of all active and inactive participants 2020-12-01 196
Number of employers contributing to the scheme 2020-12-01 0

Measure	Date	Value
2021: IMMUTA INC HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	196
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	242
Number of retired or separated participants receiving benefits	2021-12-01	0
Number of other retired or separated participants entitled to future benefits	2021-12-01	0
Total of all active and inactive participants	2021-12-01	242
2020: IMMUTA INC HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-12-01	110
Total number of active participants reported on line 7a of the Form 5500	2020-12-01	196
Number of retired or separated participants receiving benefits	2020-12-01	0
Number of other retired or separated participants entitled to future benefits	2020-12-01	0
Total of all active and inactive participants	2020-12-01	196
Number of employers contributing to the scheme	2020-12-01	0

Form 5500 Responses for IMMUTA INC HEALTH & WELFARE PLAN

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

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

567555

Policy instance

Insurance contract or identification number	567555
Number of Individuals Covered	242
Insurance policy start date	2021-12-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $10,175
Total amount of fees paid to insurance company	USD $5,325
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, OPTIONAL ACCIDENTAL DEATH AND DISMEMBERMENT
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 $124,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,177
Amount paid for insurance broker fees	5325
Additional information about fees paid to insurance broker	BONUS FEES PAID
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

567555

Policy instance

Insurance contract or identification number	567555
Number of Individuals Covered	196
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $10,522
Total amount of fees paid to insurance company	USD $5,072
Life Insurance Welfare Benefit	Yes
Temporary Disability 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 $106,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,522
Amount paid for insurance broker fees	5072
Additional information about fees paid to insurance broker	FEES
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