401k Plan data: ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN plan

ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

ZIMPERIUM HEALTH AND WELFARE BENEFIT 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

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

Company Name: ZIMPERIUM INC.

Employer identification number (EIN): 463419735

NAIC Classification: 519100

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-03-01 ANNETTE WOLF 2023-09-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-03-01	ANNETTE WOLF	2023-09-05

Plan Statistics for ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 128
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 140
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 140
Number of employers contributing to the scheme 2022-03-01 0

Measure	Date	Value
2022: ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	128
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	140
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	140
Number of employers contributing to the scheme	2022-03-01	0

Form 5500 Responses for ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN

2022: ZIMPERIUM HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	First time form 5500 has been submitted	Yes
2022-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

181393

Policy instance

Insurance contract or identification number	181393
Number of Individuals Covered	329
Insurance policy start date	2022-03-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $82,445
Total amount of fees paid to insurance company	USD $5,339
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,657,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $82,445
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OTHER COMMISSIONS, SPECIAL PROGRAMS

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VF024056

Policy instance

Insurance contract or identification number	VF024056
Number of Individuals Covered	142
Insurance policy start date	2022-03-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $15,410
Total amount of fees paid to insurance company	USD $2,879
Vision Insurance Welfare Benefit	Yes
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 $107,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,335
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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Company Name:	ZIMPERIUM INC.
Employer identification number (EIN):	463419735
NAIC Classification:	519100