401k Plan data: BUTTERFLYMX HEALTH AND WELFARE BENEFITS PLAN plan

BUTTERFLYMX HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	BUTTERFLYMX HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

BUTTERFLYMX HEALTH AND WELFARE BENEFITS 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) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: BUTTERFLYMX, INC.

Employer identification number (EIN): 455001650

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 LUCY LEMONS 2024-07-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	LUCY LEMONS	2024-07-16

Form 5500 Responses for BUTTERFLYMX HEALTH AND WELFARE BENEFITS PLAN

2023: BUTTERFLYMX HEALTH AND WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

L06456

Policy instance

Insurance contract or identification number	L06456
Number of Individuals Covered	341
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $78,163
Total amount of fees paid to insurance company	USD $13,636
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,233,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

955988

Policy instance

Insurance contract or identification number	955988
Number of Individuals Covered	195
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,828
Total amount of fees paid to insurance company	USD $5,006
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, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $152,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

123668001

Policy instance

Insurance contract or identification number	123668001
Number of Individuals Covered	0
Insurance policy start date	2023-01-01
Insurance policy end date	2023-07-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BUTTERFLYMX, INC.
Employer identification number (EIN):	455001650
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services