401k Plan data: EMERGY, INC. HEALTH AND WELFARE PLAN plan

EMERGY, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	EMERGY, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

EMERGY, INC. HEALTH AND WELFARE 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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMERGY, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-05-01 BENJAMIN HATCH 2023-10-02

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-05-01	BENJAMIN HATCH	2023-10-02

Plan Statistics for EMERGY, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for EMERGY, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: EMERGY, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-05-01 144
Total number of active participants reported on line 7a of the Form 5500 2022-05-01 303
Number of retired or separated participants receiving benefits 2022-05-01 3
Number of other retired or separated participants entitled to future benefits 2022-05-01 0
Total of all active and inactive participants 2022-05-01 306
Number of employers contributing to the scheme 2022-05-01 0

Measure	Date	Value
2022: EMERGY, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-05-01	144
Total number of active participants reported on line 7a of the Form 5500	2022-05-01	303
Number of retired or separated participants receiving benefits	2022-05-01	3
Number of other retired or separated participants entitled to future benefits	2022-05-01	0
Total of all active and inactive participants	2022-05-01	306
Number of employers contributing to the scheme	2022-05-01	0

Form 5500 Responses for EMERGY, INC. HEALTH AND WELFARE PLAN

2022: EMERGY, INC. HEALTH AND WELFARE 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

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

632599

Policy instance

Insurance contract or identification number	632599
Number of Individuals Covered	293
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $87,425
Total amount of fees paid to insurance company	USD $28,747
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $854,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $87,425
Amount paid for insurance broker fees	1037
Additional information about fees paid to insurance broker	INCENTIVE COMPENSATION
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

20461

Policy instance

Insurance contract or identification number	20461
Number of Individuals Covered	313
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $31,641
Total amount of fees paid to insurance company	USD $1,578
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, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $311,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,641
Amount paid for insurance broker fees	1578
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

HEALTHJOY, LLC (National Association of Insurance Commissioners NAIC id number: 51121 )

Policy contract number

HJ-EMERGY

Policy instance

Insurance contract or identification number	HJ-EMERGY
Number of Individuals Covered	148
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
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $5,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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