401k Plan data: SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN plan

SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN
Plan identification number	501

SIMPLE MANAGEMENT GROUP, INC 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) Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

SIMPLE MANAGEMENT GROUP, INC has sponsored the creation of one or more 401k plans.

Company Name: SIMPLE MANAGEMENT GROUP, INC

Employer identification number (EIN): 853924667

NAIC Classification: 561110
NAIC Description: Office Administrative Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-03-01 KIM MCCOMB 2023-07-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-03-01	KIM MCCOMB	2023-07-14

Plan Statistics for SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN

Measure Date Value
2022: SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 133
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 162
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 162
Number of employers contributing to the scheme 2022-03-01 0

Measure	Date	Value
2022: SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	133
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	162
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	162
Number of employers contributing to the scheme	2022-03-01	0

Form 5500 Responses for SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN

2022: SIMPLE MANAGEMENT GROUP, INC HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

ER00028874

Policy instance

Insurance contract or identification number	ER00028874
Number of Individuals Covered	125
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $967
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $8,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $381
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

38350

Policy instance

Insurance contract or identification number	38350
Number of Individuals Covered	137
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $909
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $909
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

235138

Policy instance

Insurance contract or identification number	235138
Number of Individuals Covered	162
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $806
Total amount of fees paid to insurance company	USD $81
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $806
Amount paid for insurance broker fees	81
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

625457

Policy instance

Insurance contract or identification number	625457
Number of Individuals Covered	137
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $6,478
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $6,478
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	SIMPLE MANAGEMENT GROUP, INC
Employer identification number (EIN):	853924667
NAIC Classification:	561110
NAIC Description:	Office Administrative Services