401k Plan data: INTEGRICHAIN, INC. MEDICAL PLAN plan

INTEGRICHAIN, INC. MEDICAL PLAN 401k Plan overview

Plan Name	INTEGRICHAIN, INC. MEDICAL PLAN
Plan identification number	501

INTEGRICHAIN, INC. MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

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

Company Name: INTEGRICHAIN, INC.

Employer identification number (EIN): 542187446

NAIC Classification: 518210
NAIC Description: Data Processing, Hosting, and Related Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INTEGRICHAIN, INC. MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 VICKIE KOZHUSHCHENKO 2023-07-19
501 2021-01-01 VICKIE KOZHUSHCHENKO 2022-06-13
501 2020-01-01 VICTORIA KOZHUSHCHENKO 2021-07-30

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	VICKIE KOZHUSHCHENKO	2023-07-19
501	2021-01-01	VICKIE KOZHUSHCHENKO	2022-06-13
501	2020-01-01	VICTORIA KOZHUSHCHENKO	2021-07-30

Plan Statistics for INTEGRICHAIN, INC. MEDICAL PLAN

401k plan membership statisitcs for INTEGRICHAIN, INC. MEDICAL PLAN

Measure Date Value
2022: INTEGRICHAIN, INC. MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 263
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 262
Number of retired or separated participants receiving benefits 2022-01-01 2
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 264
Number of employers contributing to the scheme 2022-01-01 0
2021: INTEGRICHAIN, INC. MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 230
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 261
Number of retired or separated participants receiving benefits 2021-01-01 5
Number of other retired or separated participants entitled to future benefits 2021-01-01 9
Total of all active and inactive participants 2021-01-01 275
Number of employers contributing to the scheme 2021-01-01 0
2020: INTEGRICHAIN, INC. MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 224
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 2020-01-01 224
Number of employers contributing to the scheme 2020-01-01 0

Measure	Date	Value
2022: INTEGRICHAIN, INC. MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	263
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	262
Number of retired or separated participants receiving benefits	2022-01-01	2
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	264
Number of employers contributing to the scheme	2022-01-01	0
2021: INTEGRICHAIN, INC. MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	230
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	261
Number of retired or separated participants receiving benefits	2021-01-01	5
Number of other retired or separated participants entitled to future benefits	2021-01-01	9
Total of all active and inactive participants	2021-01-01	275
Number of employers contributing to the scheme	2021-01-01	0
2020: INTEGRICHAIN, INC. MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	224
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	224
Number of employers contributing to the scheme	2020-01-01	0

Form 5500 Responses for INTEGRICHAIN, INC. MEDICAL PLAN

2022: INTEGRICHAIN, INC. MEDICAL PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: INTEGRICHAIN, INC. MEDICAL PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: INTEGRICHAIN, INC. MEDICAL 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

628531

Policy instance

Insurance contract or identification number	628531
Number of Individuals Covered	371
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,249
Total amount of fees paid to insurance company	USD $179,221
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,854,320
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	136050
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEES
Insurance broker organization code?	3

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Company Name:	INTEGRICHAIN, INC.
Employer identification number (EIN):	542187446
NAIC Classification:	518210
NAIC Description:	Data Processing, Hosting, and Related Services