401k Plan data: PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN plan

PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	505

PURPOSEBUILT BRANDS INC. HEALTH AND 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

PANAMERA ACQUISITION HOLDINGS, INC. D/B/A PURPOSEBUILT BRANDS, INC. has sponsored the creation of one or more 401k plans.

Company Name: PANAMERA ACQUISITION HOLDINGS, INC. D/B/A PURPOSEBUILT BRANDS, INC.

Employer identification number (EIN): 833526627

NAIC Classification: 325600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2022-01-01 ELYSE NAGELBERG 2023-06-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2022-01-01	ELYSE NAGELBERG	2023-06-07

Plan Statistics for PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 218
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 243
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 2022-01-01 243
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	218
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	243
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	243
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN

2022: PURPOSEBUILT BRANDS INC. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952231

Policy instance

Insurance contract or identification number	5952231
Number of Individuals Covered	570
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $56,633
Total amount of fees paid to insurance company	USD $10,537
Dental 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, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $441,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,633
Amount paid for insurance broker fees	4577
Additional information about fees paid to insurance broker	PRODUCER SERVICE FEES, NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

136-413798

Policy instance

Insurance contract or identification number	136-413798
Number of Individuals Covered	473
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,258
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,258
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )

Policy contract number

41482

Policy instance

Insurance contract or identification number	41482
Number of Individuals Covered	11
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,410
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,410
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	PANAMERA ACQUISITION HOLDINGS, INC. D/B/A PURPOSEBUILT BRANDS, INC.
Employer identification number (EIN):	833526627
NAIC Classification:	325600