401k Plan data: RAINTANK INC. HEALTH AND WELFARE PLAN plan

RAINTANK INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	RAINTANK INC. HEALTH AND WELFARE PLAN
Plan identification number	501

RAINTANK INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: RAINTANK INC.

Employer identification number (EIN): 472051727

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RAINTANK INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 WAILUN CHAN 2023-09-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	WAILUN CHAN	2023-09-05

Plan Statistics for RAINTANK INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for RAINTANK INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: RAINTANK INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 291
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 374
Number of retired or separated participants receiving benefits 2022-01-01 7
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 381
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: RAINTANK INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	291
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	374
Number of retired or separated participants receiving benefits	2022-01-01	7
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	381
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for RAINTANK INC. HEALTH AND WELFARE PLAN

2022: RAINTANK INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

175873

Policy instance

Insurance contract or identification number	175873
Number of Individuals Covered	878
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $16,002
Total amount of fees paid to insurance company	USD $15,120
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,630,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,002
Amount paid for insurance broker fees	15120
Additional information about fees paid to insurance broker	2022 Q1 MED NEW BUS. INCENTIVE RISK
Insurance broker organization code?	3

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

Policy contract number

27159

Policy instance

Insurance contract or identification number	27159
Number of Individuals Covered	512
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,694
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $200,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,694
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

607242

Policy instance

Insurance contract or identification number	607242
Number of Individuals Covered	30
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $180
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $217,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	180
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

ONE MEDICAL (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

GRAXOM

Policy instance

Insurance contract or identification number	GRAXOM
Number of Individuals Covered	218
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $7,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA EMPLOYEE ASSISTANCE PLAN (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

1531388

Policy instance

Insurance contract or identification number	1531388
Number of Individuals Covered	200
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	RAINTANK INC.
Employer identification number (EIN):	472051727
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services