401k Plan data: CARMEL PARTNERS HEALTH AND WELFARE PLAN plan

CARMEL PARTNERS HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	CARMEL PARTNERS HEALTH AND WELFARE PLAN
Plan identification number	501

CARMEL PARTNERS HEALTH AND WELFARE 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

CARMEL PARTNERS MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name: CARMEL PARTNERS MANAGEMENT, LLC

Employer identification number (EIN): 853272414

NAIC Classification: 236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARMEL PARTNERS HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-11-01 BRANDY FULTON 2022-05-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-11-01	BRANDY FULTON	2022-05-11

Plan Statistics for CARMEL PARTNERS HEALTH AND WELFARE PLAN

401k plan membership statisitcs for CARMEL PARTNERS HEALTH AND WELFARE PLAN

Measure Date Value
2020: CARMEL PARTNERS HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-11-01 240
Total number of active participants reported on line 7a of the Form 5500 2020-11-01 218
Number of retired or separated participants receiving benefits 2020-11-01 0
Number of other retired or separated participants entitled to future benefits 2020-11-01 0
Total of all active and inactive participants 2020-11-01 218
Number of employers contributing to the scheme 2020-11-01 0

Measure	Date	Value
2020: CARMEL PARTNERS HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-11-01	240
Total number of active participants reported on line 7a of the Form 5500	2020-11-01	218
Number of retired or separated participants receiving benefits	2020-11-01	0
Number of other retired or separated participants entitled to future benefits	2020-11-01	0
Total of all active and inactive participants	2020-11-01	218
Number of employers contributing to the scheme	2020-11-01	0

Form 5500 Responses for CARMEL PARTNERS HEALTH AND WELFARE PLAN

2020: CARMEL PARTNERS HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-11-01	Type of plan entity	Single employer plan
2020-11-01	Plan funding arrangement – Insurance	Yes
2020-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

3335108

Policy instance

Insurance contract or identification number	3335108
Number of Individuals Covered	218
Insurance policy start date	2020-11-01
Insurance policy end date	2021-10-31
Total amount of commissions paid to insurance broker	USD $120,365
Total amount of fees paid to insurance company	USD $978
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,871,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $120,365
Amount paid for insurance broker fees	978
Additional information about fees paid to insurance broker	SERVICE/GENERAL AGENT PAYMENTS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30077587

Policy instance

Insurance contract or identification number	30077587
Number of Individuals Covered	197
Insurance policy start date	2020-11-01
Insurance policy end date	2021-10-31
Total amount of commissions paid to insurance broker	USD $1,387
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,387
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

SGM607752

Policy instance

Insurance contract or identification number	SGM607752
Number of Individuals Covered	218
Insurance policy start date	2020-11-01
Insurance policy end date	2021-10-31
Total amount of commissions paid to insurance broker	USD $20,038
Total amount of fees paid to insurance company	USD $6,397
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 $210,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $13,708
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OVERRIDE

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Company Name:	CARMEL PARTNERS MANAGEMENT, LLC
Employer identification number (EIN):	853272414
NAIC Classification:	236110