401k Plan data: MILLER BROS. HEALTH & WELFARE PLAN plan

MILLER BROS. HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	MILLER BROS. HEALTH & WELFARE PLAN
Plan identification number	501

MILLER BROS. HEALTH & 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)

401k Sponsoring company profile

WAMPOLE MILLER, INC. has sponsored the creation of one or more 401k plans.

Company Name: WAMPOLE MILLER, INC.

Employer identification number (EIN): 232548775

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Additional information about WAMPOLE MILLER, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2008-12-02

Company Identification Number: 0801058114

Legal Registered Office Address: 301 ALAN WOOD RD

CONSHOHOCKEN
United States of America (USA)
19428

More information about WAMPOLE MILLER, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MILLER BROS. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-09-01 KATERINA COZZA 2024-12-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-09-01	KATERINA COZZA	2024-12-06

Form 5500 Responses for MILLER BROS. HEALTH & WELFARE PLAN

2023: MILLER BROS. HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-09-01	Type of plan entity	Single employer plan
2023-09-01	First time form 5500 has been submitted	Yes
2023-09-01	Plan funding arrangement – Insurance	Yes
2023-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

772985

Policy instance

Insurance contract or identification number	772985
Number of Individuals Covered	429
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $125,674
Total amount of fees paid to insurance company	USD $10,715
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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

TS05397004

Policy instance

Insurance contract or identification number	TS05397004
Number of Individuals Covered	481
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $12,610
Total amount of fees paid to insurance company	USD $1,016
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $93,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5659859

Policy instance

Insurance contract or identification number	E5659859
Number of Individuals Covered	14
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $2,420
Total amount of fees paid to insurance company	USD $111
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $18,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	WAMPOLE MILLER, INC.
Employer identification number (EIN):	232548775
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2008-12-02
Company Identification Number:	0801058114
Legal Registered Office Address:	301 ALAN WOOD RD CONSHOHOCKEN United States of America (USA) 19428