401k Plan data: INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN plan

INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN 401k Plan overview

Plan Name	INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN
Plan identification number	501

INTERIOR LOGIC GROUP, INC. GROUP BENEFIT 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)

401k Sponsoring company profile

INTERIOR LOGIC GROUP HOLDINGS IV, LLC has sponsored the creation of one or more 401k plans.

Company Name: INTERIOR LOGIC GROUP HOLDINGS IV, LLC

Employer identification number (EIN): 830573621

NAIC Classification: 238300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 GARY PARKINSON 2023-10-02

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	GARY PARKINSON	2023-10-02

Plan Statistics for INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN

401k plan membership statisitcs for INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN

Measure Date Value
2022: INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 3,977
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 4,574
Number of retired or separated participants receiving benefits 2022-01-01 57
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 4,631
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	3,977
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	4,574
Number of retired or separated participants receiving benefits	2022-01-01	57
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	4,631
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN

2022: INTERIOR LOGIC GROUP, INC. GROUP BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

701809

Policy instance

Insurance contract or identification number	701809
Number of Individuals Covered	4395
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $137,588
Total amount of fees paid to insurance company	USD $31,096
Life 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 $1,457,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $137,588
Amount paid for insurance broker fees	31096
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

10196481001

Policy instance

Insurance contract or identification number	10196481001
Number of Individuals Covered	4322
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $278,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )

Policy contract number

60001618

Policy instance

Insurance contract or identification number	60001618
Number of Individuals Covered	331
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $37,848
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,468,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $37,848
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

306158

Policy instance

Insurance contract or identification number	306158
Number of Individuals Covered	767
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $29,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

236259

Policy instance

Insurance contract or identification number	236259
Number of Individuals Covered	5167
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $87
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,714,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	87
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

235523

Policy instance

Insurance contract or identification number	235523
Number of Individuals Covered	145
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $994,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	INTERIOR LOGIC GROUP HOLDINGS IV, LLC
Employer identification number (EIN):	830573621
NAIC Classification:	238300