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| Plan Name | EMPOWERME WELLNESS,DENTAL, VISION, LIFE AND DISABILITY PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | EMPOWERME WELLNESS, LLC |
| Employer identification number (EIN): | 821906428 |
| NAIC Classification: | 621340 |
| NAIC Description: | Offices of Physical, Occupational and Speech Therapists, and Audiologists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2022-03-01 | MEGAN VANDYKE | 2023-06-06 | ||
| 502 | 2021-03-01 | HAYLEY CICHACKI | 2022-10-04 |
| Measure | Date | Value |
|---|---|---|
| 2022: EMPOWERME WELLNESS,DENTAL, VISION, LIFE AND DISABILITY PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-03-01 | 427 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 976 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
| Total of all active and inactive participants | 2022-03-01 | 983 |
| Number of employers contributing to the scheme | 2022-03-01 | 0 |
| 2021: EMPOWERME WELLNESS,DENTAL, VISION, LIFE AND DISABILITY PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-03-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 426 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 427 |
| Number of employers contributing to the scheme | 2021-03-01 | 0 |
| 2022: EMPOWERME WELLNESS,DENTAL, VISION, LIFE AND DISABILITY PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: EMPOWERME WELLNESS,DENTAL, VISION, LIFE AND DISABILITY PLAN 2021 form 5500 responses | ||
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | First time form 5500 has been submitted | Yes |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 584886 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 584886 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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