401k Plan data: ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN plan

ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN
Plan identification number	501

ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE 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)

401k Sponsoring company profile

ZEALTH, INC DBA NOTABLE has sponsored the creation of one or more 401k plans.

Company Name: ZEALTH, INC DBA NOTABLE

Employer identification number (EIN): 821290020

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-05-01 CHRISTINE WU 2024-01-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-05-01	CHRISTINE WU	2024-01-23

Plan Statistics for ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN

Measure Date Value
2022: ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-05-01 181
Total number of active participants reported on line 7a of the Form 5500 2022-05-01 213
Number of retired or separated participants receiving benefits 2022-05-01 1
Number of other retired or separated participants entitled to future benefits 2022-05-01 14
Total of all active and inactive participants 2022-05-01 228
Number of employers contributing to the scheme 2022-05-01 0

Measure	Date	Value
2022: ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-05-01	181
Total number of active participants reported on line 7a of the Form 5500	2022-05-01	213
Number of retired or separated participants receiving benefits	2022-05-01	1
Number of other retired or separated participants entitled to future benefits	2022-05-01	14
Total of all active and inactive participants	2022-05-01	228
Number of employers contributing to the scheme	2022-05-01	0

Form 5500 Responses for ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN

2022: ZEALTH D.B.A. NOTABLE HEALTH EMPLOYEE BENEFITS PLAN 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	First time form 5500 has been submitted	Yes
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L05439

Policy instance

Insurance contract or identification number	L05439
Number of Individuals Covered	218
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $50,612
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 $1,132,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,221
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

1156044

Policy instance

Insurance contract or identification number	1156044
Number of Individuals Covered	301
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $12,287
Total amount of fees paid to insurance company	USD $7,231
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	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $191,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,342
Amount paid for insurance broker fees	7231
Insurance broker organization code?	3

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

Policy contract number

1232841

Policy instance

Insurance contract or identification number	1232841
Number of Individuals Covered	2
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
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
Welfare Benefit Premiums Paid to Carrier	USD $3,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

607400

Policy instance

Insurance contract or identification number	607400
Number of Individuals Covered	44
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $7,502
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $220,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,502
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	ZEALTH, INC DBA NOTABLE
Employer identification number (EIN):	821290020
NAIC Classification:	541600