401k Plan data: SILFAB SOLAR, INC. HEALTH AND WELFARE PLAN plan

SILFAB SOLAR, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	SILFAB SOLAR, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

SILFAB SOLAR, INC. HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

SILFAB SOLAR WA INC. has sponsored the creation of one or more 401k plans.

Company Name: SILFAB SOLAR WA INC.

Employer identification number (EIN): 371907741

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SILFAB SOLAR, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-07-01 RENEE TERRERI 2025-01-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-07-01	RENEE TERRERI	2025-01-19

Form 5500 Responses for SILFAB SOLAR, INC. HEALTH AND WELFARE PLAN

2023: SILFAB SOLAR, INC. HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	First time form 5500 has been submitted	Yes
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

10050550

Policy instance

Insurance contract or identification number	10050550
Number of Individuals Covered	173
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $61,701
Total amount of fees paid to insurance company	USD $4,520
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,137,432
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

30084120

Policy instance

Insurance contract or identification number	30084120
Number of Individuals Covered	116
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $848
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

13043

Policy instance

Insurance contract or identification number	13043
Number of Individuals Covered	198
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $4,134
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

N/A

Policy instance

Insurance contract or identification number	N/A
Number of Individuals Covered	0
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL164337

Policy instance

Insurance contract or identification number	GL164337
Number of Individuals Covered	281
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $4,145
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, CRITICAL ILLNESS, HOSPITAL, ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $38,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SILFAB SOLAR WA INC.
Employer identification number (EIN):	371907741
NAIC Classification:	339900