401k Plan data: WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN plan

WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN
Plan identification number	501

WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-07-01

Plan Statistics for WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 350
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 488
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 2022-01-01 488
2021: WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 336
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 350
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 350

Measure	Date	Value
2022: WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	350
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	488
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	488
2021: WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	336
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	350
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	350

Form 5500 Responses for WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN

2022: WELIA HEALTH, INC. EMPLOYEE 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
2021: WELIA HEALTH, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	First time form 5500 has been submitted	Yes
2021-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0668723

Policy instance

Insurance contract or identification number	R0668723
Number of Individuals Covered	192
Insurance policy start date	2022-09-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,691
Total amount of fees paid to insurance company	USD $115
Other welfare benefits provided	GCIEE, GRPACCVO, GRPHSPVO
Welfare Benefit Premiums Paid to Carrier	USD $16,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,158
Insurance broker organization code?	3
Amount paid for insurance broker fees	115
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011247936

Policy instance

Insurance contract or identification number	0011247936
Number of Individuals Covered	159
Insurance policy start date	2022-09-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,303
Total amount of fees paid to insurance company	USD $265
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,541
Insurance broker organization code?	3
Amount paid for insurance broker fees	265
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	974
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,147,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

420872

Policy instance

Insurance contract or identification number	420872
Number of Individuals Covered	488
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,005
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $179,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,005
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

420873

Policy instance

Insurance contract or identification number	420873
Number of Individuals Covered	286
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $17,480
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $116,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,480
Insurance broker organization code?	3

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	964
Insurance policy start date	2021-07-01
Insurance policy end date	2021-12-31
Welfare Benefit Premiums Paid to Carrier	USD $516,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

420872

Policy instance

Insurance contract or identification number	420872
Number of Individuals Covered	519
Insurance policy start date	2021-07-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,184
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $196,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,184
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

420873

Policy instance

Insurance contract or identification number	420873
Number of Individuals Covered	267
Insurance policy start date	2021-07-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $16,025
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	LIFESTYLE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $106,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,025
Insurance broker organization code?	3

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