401k Plan data: CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN plan

CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN
Plan identification number	501

CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CLUTTER HOLDINGS INC, has sponsored the creation of one or more 401k plans.

Company Name: CLUTTER HOLDINGS INC,

Employer identification number (EIN): 874762089

NAIC Classification: 493100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 ERIN COLEMAN 2023-07-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	ERIN COLEMAN	2023-07-19

Plan Statistics for CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN

401k plan membership statisitcs for CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN

Measure Date Value
2022: CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 303
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 416
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 2022-01-01 416
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	303
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	416
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	416
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for CLUTTER HOLDINGS INC. WELFARE BENEFITS PLAN

2022: CLUTTER HOLDINGS INC. WELFARE BENEFITS 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

KM05969461

Policy instance

Insurance contract or identification number	KM05969461
Number of Individuals Covered	446
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $29,883
Total amount of fees paid to insurance company	USD $2,742
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $231,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,979
Amount paid for insurance broker fees	1963
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

307750

Policy instance

Insurance contract or identification number	307750
Number of Individuals Covered	416
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $8,318
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

234874

Policy instance

Insurance contract or identification number	234874
Number of Individuals Covered	42
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $15,253
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $304,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,253
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

181487

Policy instance

Insurance contract or identification number	181487
Number of Individuals Covered	169
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $57,323
Total amount of fees paid to insurance company	USD $7,500
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,217,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,323
Amount paid for insurance broker fees	7500
Additional information about fees paid to insurance broker	2022 Q1 GROW WITH US NEW BUSINESS INCENTIVE RISK
Insurance broker organization code?	3

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Company Name:	CLUTTER HOLDINGS INC,
Employer identification number (EIN):	874762089
NAIC Classification:	493100