401k Plan data: XACTUS, LLC BENEFITS PLAN plan

XACTUS, LLC BENEFITS PLAN 401k Plan overview

Plan Name	XACTUS, LLC BENEFITS PLAN
Plan identification number	501

XACTUS, LLC BENEFITS 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

CONSOLIDATED INFORMATION SERVI has sponsored the creation of one or more 401k plans.

Company Name: CONSOLIDATED INFORMATION SERVI

Employer identification number (EIN): 824454389

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan XACTUS, LLC BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 NANCY GRYCEWICZ 2023-12-06
501 2021-01-01 NANCY GRYCEWICZ 2022-09-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	NANCY GRYCEWICZ	2023-12-06
501	2021-01-01	NANCY GRYCEWICZ	2022-09-09

Plan Statistics for XACTUS, LLC BENEFITS PLAN

401k plan membership statisitcs for XACTUS, LLC BENEFITS PLAN

Measure Date Value
2022: XACTUS, LLC BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 354
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 357
Number of retired or separated participants receiving benefits 2022-01-01 10
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 367
Number of employers contributing to the scheme 2022-01-01 0
2021: XACTUS, LLC BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 255
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 350
Number of retired or separated participants receiving benefits 2021-01-01 2
Number of other retired or separated participants entitled to future benefits 2021-01-01 2
Total of all active and inactive participants 2021-01-01 354

Measure	Date	Value
2022: XACTUS, LLC BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	354
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	357
Number of retired or separated participants receiving benefits	2022-01-01	10
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	367
Number of employers contributing to the scheme	2022-01-01	0
2021: XACTUS, LLC BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	255
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	350
Number of retired or separated participants receiving benefits	2021-01-01	2
Number of other retired or separated participants entitled to future benefits	2021-01-01	2
Total of all active and inactive participants	2021-01-01	354

Form 5500 Responses for XACTUS, LLC BENEFITS PLAN

2022: XACTUS, LLC BENEFITS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: XACTUS, LLC BENEFITS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

2133148

Policy instance

Insurance contract or identification number	2133148
Number of Individuals Covered	538
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $180,940
Total amount of fees paid to insurance company	USD $14,379
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $180,940
Amount paid for insurance broker fees	14379
Additional information about fees paid to insurance broker	OVERRIDE, NON-MONETARY COMMISSIONS
Insurance broker organization code?	3

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

Policy contract number

5975604

Policy instance

Insurance contract or identification number	5975604
Number of Individuals Covered	823
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $85,563
Total amount of fees paid to insurance company	USD $30,547
Health Insurance Welfare Benefit	No
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 $587,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,254
Amount paid for insurance broker fees	5933
Additional information about fees paid to insurance broker	NON-MONETARY AND SUPPLMENTAL COMPENSATION, MARKETING FEES, SCP FIRST YEAR AND RENEWAL YEAR PAYMENTS
Insurance broker organization code?	3

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

Policy contract number

5975604

Policy instance

Insurance contract or identification number	5975604
Number of Individuals Covered	350
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $17,968
Total amount of fees paid to insurance company	USD $10,156
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $11,411
Amount paid for insurance broker fees	2617
Additional information about fees paid to insurance broker	COMMISSIONS AND FEES
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0002133148

Policy instance

Insurance contract or identification number	0002133148
Number of Individuals Covered	298
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $64,930
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $57,778
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

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Company Name:	CONSOLIDATED INFORMATION SERVI
Employer identification number (EIN):	824454389
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services