401k Plan data: INDIGO IT, LLC WELFARE BENEFIT PLAN plan

INDIGO IT, LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	INDIGO IT, LLC WELFARE BENEFIT PLAN
Plan identification number	501

INDIGO IT, LLC WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare 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) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

INDIGO IT LLC has sponsored the creation of one or more 401k plans.

Company Name: INDIGO IT LLC

Employer identification number (EIN): 542042767

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDIGO IT, LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-10-01 DENISE VAN WYNGAARDT 2023-01-13
501 2020-10-01 DENISE VAN WYNGAARDT 2022-02-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-10-01	DENISE VAN WYNGAARDT	2023-01-13
501	2020-10-01	DENISE VAN WYNGAARDT	2022-02-28

Plan Statistics for INDIGO IT, LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for INDIGO IT, LLC WELFARE BENEFIT PLAN

Measure Date Value
2021: INDIGO IT, LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 111
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 91
Number of retired or separated participants receiving benefits 2021-10-01 3
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 94
Number of employers contributing to the scheme 2021-10-01 0
2020: INDIGO IT, LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 102
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 111
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 11
Total of all active and inactive participants 2020-10-01 122
Number of employers contributing to the scheme 2020-10-01 0

Measure	Date	Value
2021: INDIGO IT, LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	111
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	91
Number of retired or separated participants receiving benefits	2021-10-01	3
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	94
Number of employers contributing to the scheme	2021-10-01	0
2020: INDIGO IT, LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	102
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	111
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	11
Total of all active and inactive participants	2020-10-01	122
Number of employers contributing to the scheme	2020-10-01	0

Form 5500 Responses for INDIGO IT, LLC WELFARE BENEFIT PLAN

2021: INDIGO IT, LLC WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: INDIGO IT, LLC WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	First time form 5500 has been submitted	Yes
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

06W0276

Policy instance

Insurance contract or identification number	06W0276
Number of Individuals Covered	213
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $35,880
Total amount of fees paid to insurance company	USD $1,434
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,442,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,880
Amount paid for insurance broker fees	1434
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

5965899

Policy instance

Insurance contract or identification number	5965899
Number of Individuals Covered	296
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $4,261
Total amount of fees paid to insurance company	USD $857
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,261
Amount paid for insurance broker fees	857
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BJ9P

Policy instance

Insurance contract or identification number	GLUG0BJ9P
Number of Individuals Covered	107
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $9,355
Total amount of fees paid to insurance company	USD $6,999
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
Welfare Benefit Premiums Paid to Carrier	USD $81,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,355
Amount paid for insurance broker fees	5249
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

06W0276

Policy instance

Insurance contract or identification number	06W0276
Number of Individuals Covered	244
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $39,270
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,529,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,270
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

5965899

Policy instance

Insurance contract or identification number	5965899
Number of Individuals Covered	372
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $4,330
Total amount of fees paid to insurance company	USD $2,413
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,330
Amount paid for insurance broker fees	2413
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BJ9P

Policy instance

Insurance contract or identification number	GLUG0BJ9P
Number of Individuals Covered	135
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $9,961
Total amount of fees paid to insurance company	USD $4,680
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
Welfare Benefit Premiums Paid to Carrier	USD $86,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,961
Amount paid for insurance broker fees	4680
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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Company Name:	INDIGO IT LLC
Employer identification number (EIN):	542042767
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services