401k Plan data: PREPASS, LLC WRAP PLAN plan

PREPASS, LLC WRAP PLAN 401k Plan overview

Plan Name	PREPASS, LLC WRAP PLAN
Plan identification number	511

PREPASS, LLC WRAP 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

401k Sponsoring company profile

CVO HOLDING COMPANY LLC has sponsored the creation of one or more 401k plans.

Company Name: CVO HOLDING COMPANY LLC

Employer identification number (EIN): 823897252

NAIC Classification: 488990

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PREPASS, LLC WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
511 2022-01-01 BRUCE EDDY 2023-06-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
511	2022-01-01	BRUCE EDDY	2023-06-05

Plan Statistics for PREPASS, LLC WRAP PLAN

401k plan membership statisitcs for PREPASS, LLC WRAP PLAN

Measure Date Value
2022: PREPASS, LLC WRAP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 288
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 293
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 4
Total of all active and inactive participants 2022-01-01 299
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: PREPASS, LLC WRAP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	288
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	293
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	4
Total of all active and inactive participants	2022-01-01	299
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for PREPASS, LLC WRAP PLAN

2022: PREPASS, LLC WRAP PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

919628

Policy instance

Insurance contract or identification number	919628
Number of Individuals Covered	567
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $16,763
Total amount of fees paid to insurance company	USD $107,379
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,163,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,763
Amount paid for insurance broker fees	104965
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30085020

Policy instance

Insurance contract or identification number	30085020
Number of Individuals Covered	203
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,760
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,755
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

308523

Policy instance

Insurance contract or identification number	308523
Number of Individuals Covered	293
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $34,794
Total amount of fees paid to insurance company	USD $0
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
Welfare Benefit Premiums Paid to Carrier	USD $182,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,794
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

218285

Policy instance

Insurance contract or identification number	218285
Number of Individuals Covered	347
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,602
Total amount of fees paid to insurance company	USD $1,187
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $54,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,742
Amount paid for insurance broker fees	126
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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Company Name:	CVO HOLDING COMPANY LLC
Employer identification number (EIN):	823897252
NAIC Classification:	488990