401k Plan data: PAX8 HEALTH AND WELFARE PLAN plan

PAX8 HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	PAX8 HEALTH AND WELFARE PLAN
Plan identification number	502

PAX8 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) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

PAX8, INC has sponsored the creation of one or more 401k plans.

Company Name: PAX8, INC

Employer identification number (EIN): 900781532

NAIC Classification: 541519
NAIC Description: Other Computer Related Services

Additional information about PAX8, INC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5084098

More information about PAX8, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAX8 HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01 LORI FRASIER 2023-06-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2022-01-01	LORI FRASIER	2023-06-23

Plan Statistics for PAX8 HEALTH AND WELFARE PLAN

401k plan membership statisitcs for PAX8 HEALTH AND WELFARE PLAN

Measure Date Value
2022: PAX8 HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 822
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,005
Number of retired or separated participants receiving benefits 2022-01-01 8
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 1,013
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: PAX8 HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	822
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,005
Number of retired or separated participants receiving benefits	2022-01-01	8
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	1,013
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for PAX8 HEALTH AND WELFARE PLAN

2022: PAX8 HEALTH AND WELFARE 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 – 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

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

Policy contract number

926106

Policy instance

Insurance contract or identification number	926106
Number of Individuals Covered	924
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
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $6,555,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30107649

Policy instance

Insurance contract or identification number	30107649
Number of Individuals Covered	912
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

725919

Policy instance

Insurance contract or identification number	725919
Number of Individuals Covered	1335
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $70,466
Total amount of fees paid to insurance company	USD $23,242
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, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $714,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,466
Amount paid for insurance broker fees	3000
Additional information about fees paid to insurance broker	WRITING AGENT
Insurance broker organization code?	3

LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	228
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,051
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $40,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,051
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

PAX8

Policy instance

Insurance contract or identification number	PAX8
Number of Individuals Covered	915
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
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $53,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	PAX8, INC
Employer identification number (EIN):	900781532
NAIC Classification:	541519
NAIC Description:	Other Computer Related Services

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5084098