401k Plan data: CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN plan

CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN
Plan identification number	501

CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CONSERVATION INTERNATIONAL has sponsored the creation of one or more 401k plans.

Company Name: CONSERVATION INTERNATIONAL

Employer identification number (EIN): 521497470

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-01-01 FRANCESCA CANTARELLA 2021-10-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-01-01	FRANCESCA CANTARELLA	2021-10-07

Plan Statistics for CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN

401k plan membership statisitcs for CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN

Measure Date Value
2020: CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 333
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 265
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 2020-01-01 265
Number of employers contributing to the scheme 2020-01-01 0

Measure	Date	Value
2020: CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	333
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	265
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	265
Number of employers contributing to the scheme	2020-01-01	0

Form 5500 Responses for CONSERVATION INTERNATIONAL HEALTH & WELFARE PLAN

2020: CONSERVATION INTERNATIONAL HEALTH & 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	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

5564863

Policy instance

Insurance contract or identification number	5564863
Number of Individuals Covered	623
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,942
Total amount of fees paid to insurance company	USD $5,810
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $347,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,942
Amount paid for insurance broker fees	5810
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION SUPPLEMENTAL COMPENSATION MARKETING FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

12170764

Policy instance

Insurance contract or identification number	12170764
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 $1,933
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,933
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

LK962249

Policy instance

Insurance contract or identification number	LK962249
Number of Individuals Covered	265
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

20410001

Policy instance

Insurance contract or identification number	20410001
Number of Individuals Covered	265
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELAWARE AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62634 )

Policy contract number

3803

Policy instance

Insurance contract or identification number	3803
Number of Individuals Covered	31
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $23,320
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $416,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,320
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	CONSERVATION INTERNATIONAL
Employer identification number (EIN):	521497470
NAIC Classification:	611000