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SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN
Plan identification number 501

SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

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

Company Name:SPAY, INC.
Employer identification number (EIN):474011165
NAIC Classification:511210
NAIC Description:Software Publishers

Additional information about SPAY, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2015-07-31
Company Identification Number: 0802264917
Legal Registered Office Address: 5360 LEGACY DR STE 150

PLANO
United States of America (USA)
75024

More information about SPAY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01JONATHON DUSSAULT2023-12-29
5012021-07-01JONATHON DUSSAULT2022-12-05
5012020-07-01JONATHON DUSSAULT2022-01-13
5012019-07-01SAMANTHA MARSH2021-01-11
5012018-07-01CASEY AMIDON2020-01-15
5012017-07-01CASEY.AMIDON@STACKSPORTS.COM
5012017-07-01
5012017-07-01

Plan Statistics for SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN

401k plan membership statisitcs for SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN

Measure Date Value
2022: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01229
Total number of active participants reported on line 7a of the Form 55002022-07-01280
Number of retired or separated participants receiving benefits2022-07-014
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01284
Number of employers contributing to the scheme2022-07-010
2021: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01425
Total number of active participants reported on line 7a of the Form 55002021-07-01466
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01466
Number of employers contributing to the scheme2021-07-010
2020: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01275
Total number of active participants reported on line 7a of the Form 55002020-07-01230
Number of retired or separated participants receiving benefits2020-07-013
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01233
Number of employers contributing to the scheme2020-07-010
2019: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01222
Total number of active participants reported on line 7a of the Form 55002019-07-01299
Number of retired or separated participants receiving benefits2019-07-0115
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01314
Number of employers contributing to the scheme2019-07-010
2018: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01318
Total number of active participants reported on line 7a of the Form 55002018-07-01215
Number of retired or separated participants receiving benefits2018-07-01223
Number of other retired or separated participants entitled to future benefits2018-07-0128
Total of all active and inactive participants2018-07-01466
Number of employers contributing to the scheme2018-07-010
2017: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01185
Total number of active participants reported on line 7a of the Form 55002017-07-01228
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01228

Form 5500 Responses for SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN

2022: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: SPAY, INC. DBA BLUE STAR SPORTS WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01First time form 5500 has been submittedYes
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberVF027440
Policy instance 2
Insurance contract or identification numberVF027440
Number of Individuals Covered280
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $21,432
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $189,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,432
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number344384
Policy instance 1
Insurance contract or identification number344384
Number of Individuals Covered407
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $117,653
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,204,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $117,653
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number921663
Policy instance 1
Insurance contract or identification number921663
Number of Individuals Covered300
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $28,124
Total amount of fees paid to insurance companyUSD $101,706
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $2,166,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,124
Amount paid for insurance broker fees101706
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number473168
Policy instance 2
Insurance contract or identification number473168
Number of Individuals Covered229
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $17,108
Total amount of fees paid to insurance companyUSD $1,996
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $114,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,108
Amount paid for insurance broker fees1996
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number921663
Policy instance 1
Insurance contract or identification number921663
Number of Individuals Covered425
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $18,941
Total amount of fees paid to insurance companyUSD $82,804
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,754,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,941
Amount paid for insurance broker fees82804
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number626421
Policy instance 1
Insurance contract or identification number626421
Number of Individuals Covered339
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $22,893
Total amount of fees paid to insurance companyUSD $96,233
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,238,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,893
Amount paid for insurance broker fees96233
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number473168
Policy instance 2
Insurance contract or identification number473168
Number of Individuals Covered286
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $11,187
Total amount of fees paid to insurance companyUSD $1,555
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $74,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,187
Amount paid for insurance broker fees1555
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number473168
Policy instance 2
Insurance contract or identification number473168
Number of Individuals Covered318
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $14,744
Total amount of fees paid to insurance companyUSD $3,932
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $98,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,744
Amount paid for insurance broker fees3932
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number911564
Policy instance 1
Insurance contract or identification number911564
Number of Individuals Covered357
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $19,827
Total amount of fees paid to insurance companyUSD $98,613
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,932,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,827
Amount paid for insurance broker fees98613
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT BONUS
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number305125
Policy instance 1
Insurance contract or identification number305125
Number of Individuals Covered255
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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
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 CarrierUSD $141,143
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number911564
Policy instance 2
Insurance contract or identification number911564
Number of Individuals Covered313
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $14,372
Total amount of fees paid to insurance companyUSD $76,274
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 CarrierUSD $1,593,833
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Commission paid to Insurance BrokerUSD $14,372
Amount paid for insurance broker fees76274
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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