401k Plan data: AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN plan

AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

AUBERGE RESORTS BENEFITS TRUST 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) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

AUBERGE RESORTS has sponsored the creation of one or more 401k plans.

Company Name: AUBERGE RESORTS

Employer identification number (EIN): 876526241

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 ROBERT MELLWIG 2023-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	ROBERT MELLWIG	2023-10-13

Plan Statistics for AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,649
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 2,150
Number of retired or separated participants receiving benefits 2022-01-01 0
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 2,150
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,649
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	2,150
Number of retired or separated participants receiving benefits	2022-01-01	0
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	2,150
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN

2022: AUBERGE RESORTS BENEFITS TRUST HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Mulitple employer plan
2022-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

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

Policy contract number

926366

Policy instance

Insurance contract or identification number	926366
Number of Individuals Covered	1298
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $98,759
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,705,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $98,759
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

607232

Policy instance

Insurance contract or identification number	607232
Number of Individuals Covered	295
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $57,940
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,953,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,940
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10359041001

Policy instance

Insurance contract or identification number	10359041001
Number of Individuals Covered	909
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,330
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,330
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ARAG INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 34738 )

Policy contract number

18885-0001-001

Policy instance

Insurance contract or identification number	18885-0001-001
Number of Individuals Covered	96
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,166
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $11,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,166
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

SA2890LF081901

Policy instance

Insurance contract or identification number	SA2890LF081901
Number of Individuals Covered	1964
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $28,180
Total amount of fees paid to insurance company	USD $17,264
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,EMPLOYEE ASSISTANCE PROGRAM,ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $210,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,180
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION, BROKER BONUS

Potentially related plans

AUBERGE RESORTS 401(K) PLAN [EIN = 680433591]

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Company Name:	AUBERGE RESORTS
Employer identification number (EIN):	876526241
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants