401k Plan data: BOONE HEALTH, INC. WELFARE BENEFIT PLAN plan

BOONE HEALTH, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	BOONE HEALTH, INC. WELFARE BENEFIT PLAN
Plan identification number	501

BOONE HEALTH, INC. WELFARE 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) Prepaid legal Long-term disability cover Other welfare benefit cover

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BOONE HEALTH, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01

Plan Statistics for BOONE HEALTH, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for BOONE HEALTH, INC. WELFARE BENEFIT PLAN

Measure Date Value
2022: BOONE HEALTH, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,316
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,342
Number of retired or separated participants receiving benefits 2022-01-01 15
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 1,357
2021: BOONE HEALTH, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,283
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,283
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 1,283

Measure	Date	Value
2022: BOONE HEALTH, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,316
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,342
Number of retired or separated participants receiving benefits	2022-01-01	15
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	1,357
2021: BOONE HEALTH, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,283
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,283
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	1,283

Form 5500 Responses for BOONE HEALTH, INC. WELFARE BENEFIT PLAN

2022: BOONE HEALTH, INC. WELFARE 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
2021: BOONE HEALTH, INC. WELFARE BENEFIT 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	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

Insurance Providers Used on plan

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

9903994

Policy instance

Insurance contract or identification number	9903994
Number of Individuals Covered	245
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $42,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3344015

Policy instance

Insurance contract or identification number	3344015
Number of Individuals Covered	2745
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $43,513
Welfare Benefit Premiums Paid to Carrier	USD $1,404,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,513
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

PD3-890LF057501

Policy instance

Insurance contract or identification number	PD3-890LF057501
Number of Individuals Covered	1338
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

PD3-890LF057503

Policy instance

Insurance contract or identification number	PD3-890LF057503
Number of Individuals Covered	1338
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	LEAVE SERVICES
Welfare Benefit Premiums Paid to Carrier	USD $50,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GF3-890LF057501

Policy instance

Insurance contract or identification number	GF3-890LF057501
Number of Individuals Covered	1360
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $1,794
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $212,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1794
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

71768-1

Policy instance

Insurance contract or identification number	71768-1
Number of Individuals Covered	2632
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $16,281
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $422,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,281
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30100411

Policy instance

Insurance contract or identification number	30100411
Number of Individuals Covered	1137
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

9903994

Policy instance

Insurance contract or identification number	9903994
Number of Individuals Covered	187
Insurance policy start date	2021-04-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $22,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3344015

Policy instance

Insurance contract or identification number	3344015
Number of Individuals Covered	2653
Insurance policy start date	2021-04-01
Insurance policy end date	2021-12-31
Welfare Benefit Premiums Paid to Carrier	USD $777,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

PD3-890LF057501

Policy instance

Insurance contract or identification number	PD3-890LF057501
Number of Individuals Covered	1283
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

PD3-890LF057503

Policy instance

Insurance contract or identification number	PD3-890LF057503
Number of Individuals Covered	1283
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	LEAVE SERVICES
Welfare Benefit Premiums Paid to Carrier	USD $41,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GF3-890LF057501

Policy instance

Insurance contract or identification number	GF3-890LF057501
Number of Individuals Covered	1070
Insurance policy start date	2021-04-01
Insurance policy end date	2021-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $181,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

717681

Policy instance

Insurance contract or identification number	717681
Number of Individuals Covered	2527
Insurance policy start date	2021-04-01
Insurance policy end date	2021-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $309,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30100411

Policy instance

Insurance contract or identification number	30100411
Number of Individuals Covered	1028
Insurance policy start date	2021-04-01
Insurance policy end date	2021-12-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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