401k Plan data: QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN plan

QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN
Plan identification number	501

QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

QUALITY TELECOM CONSULTANTS, INC. has sponsored the creation of one or more 401k plans.

Company Name: QUALITY TELECOM CONSULTANTS, INC.

Employer identification number (EIN): 943386116

NAIC Classification: 237100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-12-01 LAYUNIE MATTHEWS 2023-05-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-12-01	LAYUNIE MATTHEWS	2023-05-09

Plan Statistics for QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN

401k plan membership statisitcs for QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN

Measure Date Value
2021: QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-12-01 101
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 130
Number of retired or separated participants receiving benefits 2021-12-01 0
Number of other retired or separated participants entitled to future benefits 2021-12-01 0
Total of all active and inactive participants 2021-12-01 130
Number of employers contributing to the scheme 2021-12-01 0

Measure	Date	Value
2021: QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	101
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	130
Number of retired or separated participants receiving benefits	2021-12-01	0
Number of other retired or separated participants entitled to future benefits	2021-12-01	0
Total of all active and inactive participants	2021-12-01	130
Number of employers contributing to the scheme	2021-12-01	0

Form 5500 Responses for QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN

2021: QUALITY TELECOM CONSULTANTS HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	First time form 5500 has been submitted	Yes
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

627648

Policy instance

Insurance contract or identification number	627648
Number of Individuals Covered	270
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $48,702
Total amount of fees paid to insurance company	USD $616
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $893,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,841
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

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

Policy contract number

27786

Policy instance

Insurance contract or identification number	27786
Number of Individuals Covered	135
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $5,444
Total amount of fees paid to insurance company	USD $1,072
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,888
Amount paid for insurance broker fees	1072
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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

Policy contract number

10244343

Policy instance

Insurance contract or identification number	10244343
Number of Individuals Covered	186
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $1,279
Total amount of fees paid to insurance company	USD $76
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,279
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BROKER BONUS

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

QTCI0-001

Policy instance

Insurance contract or identification number	QTCI0-001
Number of Individuals Covered	106
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $221
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $221
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	QUALITY TELECOM CONSULTANTS, INC.
Employer identification number (EIN):	943386116
NAIC Classification:	237100