401k Plan data: YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN plan

YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

YA EMPLOYEE SERVICES, LLC HEALTH AND 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) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

YA EMPLOYEE SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name: YA EMPLOYEE SERVICES, LLC

Employer identification number (EIN): 871920812

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-04-01 ANNA SPECHT 2023-08-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-04-01	ANNA SPECHT	2023-08-22

Plan Statistics for YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-04-01 265
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 249
Number of retired or separated participants receiving benefits 2022-04-01 0
Number of other retired or separated participants entitled to future benefits 2022-04-01 0
Total of all active and inactive participants 2022-04-01 249
Number of employers contributing to the scheme 2022-04-01 0

Measure	Date	Value
2022: YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	265
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	249
Number of retired or separated participants receiving benefits	2022-04-01	0
Number of other retired or separated participants entitled to future benefits	2022-04-01	0
Total of all active and inactive participants	2022-04-01	249
Number of employers contributing to the scheme	2022-04-01	0

Form 5500 Responses for YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN

2022: YA EMPLOYEE SERVICES, LLC HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	First time form 5500 has been submitted	Yes
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )

Policy contract number

56983

Policy instance

Insurance contract or identification number	56983
Number of Individuals Covered	2
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $426
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $426
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

927605

Policy instance

Insurance contract or identification number	927605
Number of Individuals Covered	402
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $47,304
Total amount of fees paid to insurance company	USD $52,606
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $2,025,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,471
Amount paid for insurance broker fees	39527
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

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Company Name:	YA EMPLOYEE SERVICES, LLC
Employer identification number (EIN):	871920812
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services