401k Plan data: SCIENTIA VASCULAR HEALTH AND WELFARE PLAN plan

SCIENTIA VASCULAR HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	SCIENTIA VASCULAR HEALTH AND WELFARE PLAN
Plan identification number	501

SCIENTIA VASCULAR 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) Other welfare benefit cover

401k Sponsoring company profile

SCIENTIA VASCULAR LLC has sponsored the creation of one or more 401k plans.

Company Name: SCIENTIA VASCULAR LLC

Employer identification number (EIN): 873060535

NAIC Classification: 339110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SCIENTIA VASCULAR HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-05-01 KEVIN SMITH 2023-10-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-05-01	KEVIN SMITH	2023-10-05

Plan Statistics for SCIENTIA VASCULAR HEALTH AND WELFARE PLAN

401k plan membership statisitcs for SCIENTIA VASCULAR HEALTH AND WELFARE PLAN

Measure Date Value
2022: SCIENTIA VASCULAR HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-05-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-05-01 172
Number of retired or separated participants receiving benefits 2022-05-01 0
Number of other retired or separated participants entitled to future benefits 2022-05-01 0
Total of all active and inactive participants 2022-05-01 172
Number of employers contributing to the scheme 2022-05-01 0

Measure	Date	Value
2022: SCIENTIA VASCULAR HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-05-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-05-01	172
Number of retired or separated participants receiving benefits	2022-05-01	0
Number of other retired or separated participants entitled to future benefits	2022-05-01	0
Total of all active and inactive participants	2022-05-01	172
Number of employers contributing to the scheme	2022-05-01	0

Form 5500 Responses for SCIENTIA VASCULAR HEALTH AND WELFARE PLAN

2022: SCIENTIA VASCULAR HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	First time form 5500 has been submitted	Yes
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 )

Policy contract number

G1013539

Policy instance

Insurance contract or identification number	G1013539
Number of Individuals Covered	291
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $52,600
Total amount of fees paid to insurance company	USD $11,572
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,050,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,600
Amount paid for insurance broker fees	11572
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 12515 )

Policy contract number

3671

Policy instance

Insurance contract or identification number	3671
Number of Individuals Covered	325
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $10,982
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $109,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,982
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0C4F2

Policy instance

Insurance contract or identification number	GLTD0C4F2
Number of Individuals Covered	172
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $11,039
Total amount of fees paid to insurance company	USD $2,443
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
Welfare Benefit Premiums Paid to Carrier	USD $111,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,039
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OTHER COMPENSATION

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Company Name:	SCIENTIA VASCULAR LLC
Employer identification number (EIN):	873060535
NAIC Classification:	339110