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THE OPEN DOOR NETWORK BENEFIT PLAN 401k Plan overview

Plan NameTHE OPEN DOOR NETWORK BENEFIT PLAN
Plan identification number 501

THE OPEN DOOR NETWORK BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

THE OPEN DOOR NETWORK has sponsored the creation of one or more 401k plans.

Company Name:THE OPEN DOOR NETWORK
Employer identification number (EIN):953604240
NAIC Classification:624200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE OPEN DOOR NETWORK BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01KATHERINE GOMEZ2023-04-24 KATHERINE GOMEZ2023-04-24

Plan Statistics for THE OPEN DOOR NETWORK BENEFIT PLAN

401k plan membership statisitcs for THE OPEN DOOR NETWORK BENEFIT PLAN

Measure Date Value
2021: THE OPEN DOOR NETWORK BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-010
Total number of active participants reported on line 7a of the Form 55002021-12-01165
Total of all active and inactive participants2021-12-01165

Form 5500 Responses for THE OPEN DOOR NETWORK BENEFIT PLAN

2021: THE OPEN DOOR NETWORK BENEFIT PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01First time form 5500 has been submittedYes
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number298168
Policy instance 1
Insurance contract or identification number298168
Number of Individuals Covered64
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $11,902
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $376,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,902
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )
Policy contract number18703
Policy instance 2
Insurance contract or identification number18703
Number of Individuals Covered83
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $1,557
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,557
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number
Policy instance 3
Number of Individuals Covered126
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $2,224
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASICAD&D AND LIFE
Welfare Benefit Premiums Paid to CarrierUSD $24,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,224
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10204391001
Policy instance 4
Insurance contract or identification number10204391001
Number of Individuals Covered99
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $683
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $683
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3

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