401k Plan data: CONNECTIVITY WIRELESS, INC. WELFARE BENEFIT PLAN plan

CONNECTIVITY WIRELESS, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CONNECTIVITY WIRELESS, INC. WELFARE BENEFIT PLAN
Plan identification number	501

CONNECTIVITY WIRELESS, INC. 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

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

Company Name: CONNECTIVITY WIRELESS, INC.

Employer identification number (EIN): 262188150

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONNECTIVITY WIRELESS, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2013-03-01 WILLIAM DAVIS
501 2013-03-01 ANDI BROWN 2024-08-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2013-03-01	WILLIAM DAVIS
501	2013-03-01	ANDI BROWN	2024-08-01

Form 5500 Responses for CONNECTIVITY WIRELESS, INC. WELFARE BENEFIT PLAN

2013: CONNECTIVITY WIRELESS, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	First time form 5500 has been submitted	Yes
2013-03-01	Submission has been amended	No
2013-03-01	This submission is the final filing	No
2013-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-03-01	Plan is a collectively bargained plan	No
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

485390

Policy instance

Insurance contract or identification number	485390
Number of Individuals Covered	122
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $9,554
Total amount of fees paid to insurance company	USD $0
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
Welfare Benefit Premiums Paid to Carrier	USD $124,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

60880

Policy instance

Insurance contract or identification number	60880
Number of Individuals Covered	101
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $40,318
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $846,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

9174421

Policy instance

Insurance contract or identification number	9174421
Number of Individuals Covered	14
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $86
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $3,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CONNECTIVITY WIRELESS, INC.
Employer identification number (EIN):	262188150
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services