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| Plan Name | NOVALIS US, LLC WELFARE BENEFITS PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | NOVALIS US LLC |
| Employer identification number (EIN): | 831710316 |
| NAIC Classification: | 493100 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2022-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2022: NOVALIS US, LLC WELFARE BENEFITS PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 308 |
| 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 | 308 |
| Measure | Date | Value |
|---|---|---|
| 2022 : NOVALIS US, LLC WELFARE BENEFITS PLAN 2022 401k financial data | ||
| Total income from all sources | 2022-12-31 | $0 |
| Total plan assets at end of year | 2022-12-31 | $0 |
| Total plan assets at beginning of year | 2022-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $0 |
| 2022: NOVALIS US, LLC WELFARE BENEFITS 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 – 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 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 00576036 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | L00652 | ||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||
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