401k Plan data: TRUSTWELL HEALTH AND WELFARE BENEFIT PLAN plan

TRUSTWELL HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	TRUSTWELL HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

TRUSTWELL 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) Other welfare benefit cover

401k Sponsoring company profile

ESHA RESEARCH, INC. has sponsored the creation of one or more 401k plans.

Company Name: ESHA RESEARCH, INC.

Employer identification number (EIN): 930777394

NAIC Classification: 541700

Additional information about ESHA RESEARCH, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1981-01-19

Company Identification Number: 15005416

Legal Registered Office Address: 4747 SKYLINE RD S STE 100

SALEM
United States of America (USA)
97306

More information about ESHA RESEARCH, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRUSTWELL HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 DAVID GULLEY 2024-08-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	DAVID GULLEY	2024-08-13

Form 5500 Responses for TRUSTWELL HEALTH AND WELFARE BENEFIT PLAN

2023: TRUSTWELL HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

44997

Policy instance

Insurance contract or identification number	44997
Number of Individuals Covered	113
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $15,570
Total amount of fees paid to insurance company	USD $5,019
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $103,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

18161

Policy instance

Insurance contract or identification number	18161
Number of Individuals Covered	1
Insurance policy start date	2023-03-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $155
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0192500-0192550

Policy instance

Insurance contract or identification number	0192500-0192550
Number of Individuals Covered	184
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $13,075
Total amount of fees paid to insurance company	USD $27,254
Health Insurance Welfare Benefit	Yes
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
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $1,144,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ESHA RESEARCH, INC.
Employer identification number (EIN):	930777394
NAIC Classification:	541700

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1981-01-19
Company Identification Number:	15005416
Legal Registered Office Address:	4747 SKYLINE RD S STE 100 SALEM United States of America (USA) 97306