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| Plan Name | GRIDIRON IT HEALTH & WELFARE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GRIDIRON IT SOLUTIONS LLC |
| Employer identification number (EIN): | 823531747 |
| NAIC Classification: | 238900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2022-02-01 | JENNIFER HEIN | 2023-08-17 |
| Measure | Date | Value |
|---|---|---|
| 2022: GRIDIRON IT HEALTH & WELFARE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-02-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 179 |
| Number of retired or separated participants receiving benefits | 2022-02-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
| Total of all active and inactive participants | 2022-02-01 | 180 |
| Number of employers contributing to the scheme | 2022-02-01 | 0 |
| 2022: GRIDIRON IT HEALTH & WELFARE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | First time form 5500 has been submitted | Yes |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0927226 | ||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||
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| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) | |||||||||||||||||||||||||||||||||||||||
| Policy contract number | A15491000 | ||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |||||||||||||||||||||||||||||||||||||||
| Policy contract number | 10277521001 | ||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |||||||||||||||||||||||||||||||||||||||
| Policy contract number | 10260864 | ||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||
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