401k Plan data: OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN plan

OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN 401k Plan overview

Plan Name	OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN
Plan identification number	501

OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

OWLS HEAD ALLOYS INC has sponsored the creation of one or more 401k plans.

Company Name: OWLS HEAD ALLOYS INC

Employer identification number (EIN): 611250715

NAIC Classification: 331310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-10-01 TRAVIS JONES 2023-05-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-10-01	TRAVIS JONES	2023-05-26

Plan Statistics for OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN

401k plan membership statisitcs for OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN

Measure Date Value
2021: OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 102
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 108
Total of all active and inactive participants 2021-10-01 108

Measure	Date	Value
2021: OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	102
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	108
Total of all active and inactive participants	2021-10-01	108

Form 5500 Responses for OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN

2021: OWL'S HEAD ALLOYS, INC. HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	First time form 5500 has been submitted	Yes
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SIRIUS AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38776 )

Policy contract number

EBSL-1004-21

Policy instance

Insurance contract or identification number	EBSL-1004-21
Number of Individuals Covered	108
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $36,786
Welfare Benefit Premiums Paid to Carrier	USD $265,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,522
Insurance broker organization code?	3

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Company Name:	OWLS HEAD ALLOYS INC
Employer identification number (EIN):	611250715
NAIC Classification:	331310