401k Plan data: EVERNEST, LLC HEALTH AND WELFARE BENEFIT PLAN plan

EVERNEST, LLC HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	EVERNEST, LLC HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

EVERNEST, LLC HEALTH AND 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)

401k Sponsoring company profile

EVERNEST, LLC has sponsored the creation of one or more 401k plans.

Company Name: EVERNEST, LLC

Employer identification number (EIN): 808684015

NAIC Classification: 531310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EVERNEST, LLC HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 GRAHAM ROBINSON 2024-06-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	GRAHAM ROBINSON	2024-06-27

Form 5500 Responses for EVERNEST, LLC HEALTH AND WELFARE BENEFIT PLAN

2023: EVERNEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

94394

Policy instance

Insurance contract or identification number	94394
Number of Individuals Covered	271
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
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?	No

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

Policy contract number

TM05392717

Policy instance

Insurance contract or identification number	TM05392717
Number of Individuals Covered	292
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $13,240
Total amount of fees paid to insurance company	USD $2,080
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

71045

Policy instance

Insurance contract or identification number	71045
Number of Individuals Covered	260
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $9,934
Total amount of fees paid to insurance company	USD $7,492
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $66,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

EVERNEST, LLC 401(K) PLAN [EIN = 800158684]

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Company Name:	EVERNEST, LLC
Employer identification number (EIN):	808684015
NAIC Classification:	531310