401k Plan data: PRL HEALTH AND WELFARE PLAN plan

PRL HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	PRL HEALTH AND WELFARE PLAN
Plan identification number	501

PRL HEALTH AND WELFARE 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

PRL INDUSTRIES has sponsored the creation of one or more 401k plans.

Company Name: PRL INDUSTRIES

Employer identification number (EIN): 231713914

NAIC Classification: 331500

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 NICHOLE MOORE 2023-08-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	NICHOLE MOORE	2023-08-22

Form 5500 Responses for PRL HEALTH AND WELFARE PLAN

2022: PRL HEALTH AND WELFARE 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	This submission is the final filing	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

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

946247

Policy instance

Insurance contract or identification number	946247
Number of Individuals Covered	126
Insurance policy start date	2022-01-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $2,109
Total amount of fees paid to insurance company	USD $1,898
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 $47,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

04742-02,1002

Policy instance

Insurance contract or identification number	04742-02,1002
Number of Individuals Covered	187
Insurance policy start date	2022-01-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $1,382
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

5000-4071001

Policy instance

Insurance contract or identification number	5000-4071001
Number of Individuals Covered	176
Insurance policy start date	2022-01-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $559
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	PRL INDUSTRIES
Employer identification number (EIN):	231713914
NAIC Classification:	331500