401k Plan data: CREDIT ONE BANK, N.A. WELFARE BENEFIT PLAN plan

CREDIT ONE BANK, N.A. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CREDIT ONE BANK, N.A. WELFARE BENEFIT PLAN
Plan identification number	501

CREDIT ONE BANK, N.A. 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

CREDIT ONE BANK, N.A. has sponsored the creation of one or more 401k plans.

Company Name: CREDIT ONE BANK, N.A.

Employer identification number (EIN): 942841595

NAIC Classification: 522210
NAIC Description: Credit Card Issuing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CREDIT ONE BANK, N.A. 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 ZACHARY WESTBOOK 2024-06-19
501 2022-01-01 ZACHARY WESTBOOK 2023-07-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	ZACHARY WESTBOOK	2024-06-19
501	2022-01-01	ZACHARY WESTBOOK	2023-07-17

Form 5500 Responses for CREDIT ONE BANK, N.A. WELFARE BENEFIT PLAN

2023: CREDIT ONE BANK, N.A. WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
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
2022: CREDIT ONE BANK, N.A. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )

Policy contract number

50502027

Policy instance

Insurance contract or identification number	50502027
Number of Individuals Covered	1959
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $266,711
Total amount of fees paid to insurance company	USD $102,581
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,435,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

309404

Policy instance

Insurance contract or identification number	309404
Number of Individuals Covered	537
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $22,529
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $195,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30066695

Policy instance

Insurance contract or identification number	30066695
Number of Individuals Covered	1081
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,519
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5955389

Policy instance

Insurance contract or identification number	5955389
Number of Individuals Covered	2027
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $9,009
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $556,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

CM10002385

Policy instance

Insurance contract or identification number	CM10002385
Number of Individuals Covered	1168
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $55,664
Total amount of fees paid to insurance company	USD $10,828
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
Welfare Benefit Premiums Paid to Carrier	USD $622,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5955389

Policy instance

Insurance contract or identification number	5955389
Number of Individuals Covered	2471
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,325
Total amount of fees paid to insurance company	USD $2,231
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $482,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CREDIT ONE BANK, N.A.
Employer identification number (EIN):	942841595
NAIC Classification:	522210
NAIC Description:	Credit Card Issuing