401k Plan data: NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN plan

NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN
Plan identification number	503

NIPPON DYNAWAVE PACKAGING CO. HEALTH & 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 Other welfare benefit cover

401k Sponsoring company profile

NIPPON DYNAWAVE PACKAGING CO. has sponsored the creation of one or more 401k plans.

Company Name: NIPPON DYNAWAVE PACKAGING CO.

Employer identification number (EIN): 813044511

NAIC Classification: 322100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01 MONICA HARDING 2023-10-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2022-01-01	MONICA HARDING	2023-10-10

Plan Statistics for NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN

401k plan membership statisitcs for NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN

Measure Date Value
2022: NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 509
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 521
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 521
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	509
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	521
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	521
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN

2022: NIPPON DYNAWAVE PACKAGING CO. HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

22120

Policy instance

Insurance contract or identification number	22120
Number of Individuals Covered	511
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,501,823
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

09221

Policy instance

Insurance contract or identification number	09221
Number of Individuals Covered	1442
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
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

VIVACITY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0000

Policy instance

Insurance contract or identification number	0000
Number of Individuals Covered	521
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $9,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

136-414033

Policy instance

Insurance contract or identification number	136-414033
Number of Individuals Covered	770
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $37,265
Total amount of fees paid to insurance company	USD $12,295
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $686,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,265
Amount paid for insurance broker fees	12295
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?	3

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Company Name:	NIPPON DYNAWAVE PACKAGING CO.
Employer identification number (EIN):	813044511
NAIC Classification:	322100