401k Plan data: EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN plan

EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN
Plan identification number	501

EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

EXPRESS WASH CONCEPTS has sponsored the creation of one or more 401k plans.

Company Name: EXPRESS WASH CONCEPTS

Employer identification number (EIN): 825188901

NAIC Classification: 811190

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-10-01 AMBER FAVUZZI 2023-05-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-10-01	AMBER FAVUZZI	2023-05-24

Plan Statistics for EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN

401k plan membership statisitcs for EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN

Measure Date Value
2021: EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 253
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 468
Number of retired or separated participants receiving benefits 2021-10-01 2
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 470
Number of employers contributing to the scheme 2021-10-01 0

Measure	Date	Value
2021: EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	253
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	468
Number of retired or separated participants receiving benefits	2021-10-01	2
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	470
Number of employers contributing to the scheme	2021-10-01	0

Form 5500 Responses for EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN

2021: EXPRESS WASH CONCEPTS HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	First time form 5500 has been submitted	Yes
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	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

06L8780

Policy instance

Insurance contract or identification number	06L8780
Number of Individuals Covered	207
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $47,850
Total amount of fees paid to insurance company	USD $1,579
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $867,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,290
Amount paid for insurance broker fees	1579
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

KM05391923

Policy instance

Insurance contract or identification number	KM05391923
Number of Individuals Covered	468
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $10,335
Total amount of fees paid to insurance company	USD $643
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $89,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,736
Amount paid for insurance broker fees	643
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

15646

Policy instance

Insurance contract or identification number	15646
Number of Individuals Covered	707
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

EXPRESS WASH 401(K) PLAN [EIN = 352716454]

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Company Name:	EXPRESS WASH CONCEPTS
Employer identification number (EIN):	825188901
NAIC Classification:	811190