401k Plan data: MYTHIC INC HEALTH AND WELFARE PLAN plan

MYTHIC INC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	MYTHIC INC HEALTH AND WELFARE PLAN
Plan identification number	501

MYTHIC INC 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 Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: MYTHIC, INC

Employer identification number (EIN): 471012224

NAIC Classification: 541600

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-01-01 EMILY STOLTMAN 2022-05-17
501 2020-01-01 ANITA LIM-FRITZ 2021-05-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-01-01	EMILY STOLTMAN	2022-05-17
501	2020-01-01	ANITA LIM-FRITZ	2021-05-07

Plan Statistics for MYTHIC INC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for MYTHIC INC HEALTH AND WELFARE PLAN

Measure Date Value
2021: MYTHIC INC HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 127
Number of retired or separated participants receiving benefits 2021-01-01 2
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 129
Number of employers contributing to the scheme 2021-01-01 0
2020: MYTHIC INC HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 103
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 103
Number of employers contributing to the scheme 2020-01-01 0

Measure	Date	Value
2021: MYTHIC INC HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	127
Number of retired or separated participants receiving benefits	2021-01-01	2
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	129
Number of employers contributing to the scheme	2021-01-01	0
2020: MYTHIC INC HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	103
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	103
Number of employers contributing to the scheme	2020-01-01	0

Form 5500 Responses for MYTHIC INC HEALTH AND WELFARE PLAN

2021: MYTHIC INC HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: MYTHIC INC HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	First time form 5500 has been submitted	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

718087

Policy instance

Insurance contract or identification number	718087
Number of Individuals Covered	9
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,837
Total amount of fees paid to insurance company	USD $21
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,837
Amount paid for insurance broker fees	21
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

579427

Policy instance

Insurance contract or identification number	579427
Number of Individuals Covered	130
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $21,626
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
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	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $216,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,626
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

718087

Policy instance

Insurance contract or identification number	718087
Number of Individuals Covered	8
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,531
Total amount of fees paid to insurance company	USD $156
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,531
Amount paid for insurance broker fees	156
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1104017

Policy instance

Insurance contract or identification number	1104017
Number of Individuals Covered	243
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $20,750
Total amount of fees paid to insurance company	USD $6,766
Dental Insurance Welfare Benefit	Yes
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	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $203,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,750
Amount paid for insurance broker fees	6766
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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Company Name:	MYTHIC, INC
Employer identification number (EIN):	471012224
NAIC Classification:	541600