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H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameH2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 501

H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare 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

H2 HOLDCO, INC. DBA H2HEALTH has sponsored the creation of one or more 401k plans.

Company Name:H2 HOLDCO, INC. DBA H2HEALTH
Employer identification number (EIN):843226050
NAIC Classification:621399
NAIC Description:Offices of All Other Miscellaneous Health Practitioners

Additional information about H2 HOLDCO, INC. DBA H2HEALTH

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2020-07-10
Company Identification Number: 0803684059
Legal Registered Office Address: 484 RIVERSIDE AVE

JACKSONVILLE
United States of America (USA)
32202

More information about H2 HOLDCO, INC. DBA H2HEALTH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-02-01TIMOTHY HUGHES2023-08-03
5012021-02-01TIMOTHY HUGHES2022-08-21
5012020-02-01TIMOTHY HUGHES2021-07-30

Plan Statistics for H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01720
Total number of active participants reported on line 7a of the Form 55002022-02-01469
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01469
Number of employers contributing to the scheme2022-02-010
2021: H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01386
Total number of active participants reported on line 7a of the Form 55002021-02-01717
Number of retired or separated participants receiving benefits2021-02-013
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01720
Number of employers contributing to the scheme2021-02-010
2020: H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01281
Total number of active participants reported on line 7a of the Form 55002020-02-01386
Number of retired or separated participants receiving benefits2020-02-016
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01392
Number of employers contributing to the scheme2020-02-010

Form 5500 Responses for H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN

2022: H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan funding arrangement – General assets of the sponsorYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – General assets of the sponsorYes
2021: H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan funding arrangement – General assets of the sponsorYes
2021-02-01Plan benefit arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – General assets of the sponsorYes
2020: H2 HOLDCO, INC. HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01First time form 5500 has been submittedYes
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan funding arrangement – General assets of the sponsorYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number149356
Policy instance 1
Insurance contract or identification number149356
Number of Individuals Covered1102
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $42,851
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,690,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $34,207
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number474539
Policy instance 2
Insurance contract or identification number474539
Number of Individuals Covered943
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $54,273
Total amount of fees paid to insurance companyUSD $7,689
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $469,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,551
Amount paid for insurance broker fees7689
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number474542
Policy instance 3
Insurance contract or identification number474542
Number of Individuals Covered165
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $7,815
Total amount of fees paid to insurance companyUSD $1,289
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $52,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,815
Amount paid for insurance broker fees1289
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number149356
Policy instance 1
Insurance contract or identification number149356
Number of Individuals Covered823
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $24,159
Total amount of fees paid to insurance companyUSD $135,094
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,600,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $24,159
Amount paid for insurance broker fees135094
Additional information about fees paid to insurance broker2020 PINNACLE SPECIALTY NEWBUSINESS INCENTIVE RISK, INDIRECT COMPENSATION, DIRECT COMPENSATION
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number474541
Policy instance 2
Insurance contract or identification number474541
Number of Individuals Covered136
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $4,861
Total amount of fees paid to insurance companyUSD $544
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $46,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,861
Amount paid for insurance broker fees544
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number474539
Policy instance 3
Insurance contract or identification number474539
Number of Individuals Covered609
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $39,602
Total amount of fees paid to insurance companyUSD $4,061
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $275,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,469
Amount paid for insurance broker fees4061
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number149356
Policy instance 1
Insurance contract or identification number149356
Number of Individuals Covered568
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $16,714
Total amount of fees paid to insurance companyUSD $93,595
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,684,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $16,714
Amount paid for insurance broker fees93595
Additional information about fees paid to insurance brokerDIRECT COMPENSATION
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number474541
Policy instance 2
Insurance contract or identification number474541
Number of Individuals Covered111
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $5,413
Total amount of fees paid to insurance companyUSD $1,113
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $39,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,413
Amount paid for insurance broker fees1113
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number474539
Policy instance 3
Insurance contract or identification number474539
Number of Individuals Covered383
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $31,000
Total amount of fees paid to insurance companyUSD $9,248
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $218,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,589
Amount paid for insurance broker fees9248
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3

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