401k Plan data: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN plan

EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 401k Plan overview

Plan Name	EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN
Plan identification number	501

EMPOWER RETIREMENT LLC EMP WELFARE BEN 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

EMPOWER RETIREMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name: EMPOWER RETIREMENT, LLC

Employer identification number (EIN): 841233483

NAIC Classification: 524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 KELLEY FERGUSON 2023-07-21
501 2021-01-01 KELLEY FERGUSON 2022-09-19
501 2020-01-01 KELLEY FERGUSON 2021-07-14
501 2020-01-01 KELLEY FERGUSON 2022-09-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	KELLEY FERGUSON	2023-07-21
501	2021-01-01	KELLEY FERGUSON	2022-09-19
501	2020-01-01	KELLEY FERGUSON	2021-07-14
501	2020-01-01	KELLEY FERGUSON	2022-09-19

Plan Statistics for EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN

401k plan membership statisitcs for EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN

Measure Date Value
2022: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 7,988
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 9,848
Number of retired or separated participants receiving benefits 2022-01-01 118
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 9,966
Number of employers contributing to the scheme 2022-01-01 0
2021: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 5,430
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 7,685
Number of retired or separated participants receiving benefits 2021-01-01 73
Number of other retired or separated participants entitled to future benefits 2021-01-01 230
Total of all active and inactive participants 2021-01-01 7,988
Number of employers contributing to the scheme 2021-01-01 0
2020: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 5,447
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 5,282
Number of retired or separated participants receiving benefits 2020-01-01 51
Number of other retired or separated participants entitled to future benefits 2020-01-01 97
Total of all active and inactive participants 2020-01-01 5,430
Number of employers contributing to the scheme 2020-01-01 0

Measure	Date	Value
2022: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	7,988
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	9,848
Number of retired or separated participants receiving benefits	2022-01-01	118
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	9,966
Number of employers contributing to the scheme	2022-01-01	0
2021: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	5,430
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	7,685
Number of retired or separated participants receiving benefits	2021-01-01	73
Number of other retired or separated participants entitled to future benefits	2021-01-01	230
Total of all active and inactive participants	2021-01-01	7,988
Number of employers contributing to the scheme	2021-01-01	0
2020: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	5,447
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	5,282
Number of retired or separated participants receiving benefits	2020-01-01	51
Number of other retired or separated participants entitled to future benefits	2020-01-01	97
Total of all active and inactive participants	2020-01-01	5,430
Number of employers contributing to the scheme	2020-01-01	0

Form 5500 Responses for EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN

2022: EMPOWER RETIREMENT LLC EMP WELFARE BEN 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
2021: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: EMPOWER RETIREMENT LLC EMP WELFARE BEN PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

21173

Policy instance

Insurance contract or identification number	21173
Number of Individuals Covered	9896
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $143,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL163269

Policy instance

Insurance contract or identification number	235933
Number of Individuals Covered	112
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $6,163
Total amount of fees paid to insurance company	USD $3,150
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	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 $243,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,163
Insurance broker organization code?	3
Amount paid for insurance broker fees	3150
Additional information about fees paid to insurance broker	BONUS
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT,CRITICAL ILLNESS

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

Policy contract number

21173

Policy instance

Insurance contract or identification number	21173
Number of Individuals Covered	7647
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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 $140,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLK960368

Policy instance

Insurance contract or identification number	FLK960368
Number of Individuals Covered	7685
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $63,934
Total amount of fees paid to insurance company	USD $106,555
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,137,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $63,930
Amount paid for insurance broker fees	106549
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL163269

Policy instance

Insurance contract or identification number	GL163269
Number of Individuals Covered	7560
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $79,254
Total amount of fees paid to insurance company	USD $124,669
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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,ACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $2,493,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $79,254
Amount paid for insurance broker fees	124669
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?	3

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

Policy contract number

21173

Policy instance

Insurance contract or identification number	21173
Number of Individuals Covered	5250
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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 $96,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLK960368

Policy instance

Insurance contract or identification number	FLK960368
Number of Individuals Covered	5282
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $122,014
Total amount of fees paid to insurance company	USD $251,584
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,071,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $122,014
Amount paid for insurance broker fees	251584
Additional information about fees paid to insurance broker	SALES AND SERVICE OVERRIDE
Insurance broker organization code?	3

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Company Name:	EMPOWER RETIREMENT, LLC
Employer identification number (EIN):	841233483
NAIC Classification:	524290