401k Plan data: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN plan

ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 401k Plan overview

Plan Name	ONESHARE HEALTH, LLC WRAP BENEFIT PLAN
Plan identification number	501

ONESHARE HEALTH, LLC WRAP 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) Other welfare benefit cover

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ONESHARE HEALTH, LLC WRAP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 AMBER JOHNSON 2023-08-25
501 2021-01-01 AMBER JOHNSON 2022-06-14
501 2020-06-01 VALERIE WAVRUSA 2021-06-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	AMBER JOHNSON	2023-08-25
501	2021-01-01	AMBER JOHNSON	2022-06-14
501	2020-06-01	VALERIE WAVRUSA	2021-06-24

Plan Statistics for ONESHARE HEALTH, LLC WRAP BENEFIT PLAN

401k plan membership statisitcs for ONESHARE HEALTH, LLC WRAP BENEFIT PLAN

Measure Date Value
2022: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 125
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 125
Number of employers contributing to the scheme 2022-01-01 0
2021: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 138
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 138
Number of employers contributing to the scheme 2021-01-01 0
2020: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-06-01 194
Total number of active participants reported on line 7a of the Form 5500 2020-06-01 158
Number of retired or separated participants receiving benefits 2020-06-01 4
Number of other retired or separated participants entitled to future benefits 2020-06-01 15
Total of all active and inactive participants 2020-06-01 177
Number of employers contributing to the scheme 2020-06-01 0

Measure	Date	Value
2022: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	125
Number of retired or separated participants receiving benefits	2022-01-01	0
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	125
Number of employers contributing to the scheme	2022-01-01	0
2021: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	138
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	138
Number of employers contributing to the scheme	2021-01-01	0
2020: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-06-01	194
Total number of active participants reported on line 7a of the Form 5500	2020-06-01	158
Number of retired or separated participants receiving benefits	2020-06-01	4
Number of other retired or separated participants entitled to future benefits	2020-06-01	15
Total of all active and inactive participants	2020-06-01	177
Number of employers contributing to the scheme	2020-06-01	0

Form 5500 Responses for ONESHARE HEALTH, LLC WRAP BENEFIT PLAN

2022: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ONESHARE HEALTH, LLC WRAP BENEFIT PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	First time form 5500 has been submitted	Yes
2020-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

926618

Policy instance

Insurance contract or identification number	926618
Number of Individuals Covered	155
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $15,734
Total amount of fees paid to insurance company	USD $42,277
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $816,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,578
Amount paid for insurance broker fees	36066
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

270740

Policy instance

Insurance contract or identification number	270740
Number of Individuals Covered	189
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $67,587
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,155,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $51,990
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F025659

Policy instance

Insurance contract or identification number	F025659
Number of Individuals Covered	138
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,809
Total amount of fees paid to insurance company	USD $2,805
Vision Insurance Welfare Benefit	Yes
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, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $67,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,809
Amount paid for insurance broker fees	2805
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1111779

Policy instance

Insurance contract or identification number	1111779
Number of Individuals Covered	181
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,716
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,715
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

574959

Policy instance

Insurance contract or identification number	574959
Number of Individuals Covered	76
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $30,562
Total amount of fees paid to insurance company	USD $1,344
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $54,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,393
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

270740

Policy instance

Insurance contract or identification number	270740
Number of Individuals Covered	244
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $65,988
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $606,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $39,900
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F025659

Policy instance

Insurance contract or identification number	F025659
Number of Individuals Covered	259
Insurance policy start date	2020-06-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,901
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
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, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $56,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,901
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1111779

Policy instance

Insurance contract or identification number	1111779
Number of Individuals Covered	278
Insurance policy start date	2020-06-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,361
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $55,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,361
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

574959

Policy instance

Insurance contract or identification number	574959
Number of Individuals Covered	119
Insurance policy start date	2020-06-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $25,166
Total amount of fees paid to insurance company	USD $325
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $35,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,616
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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