401k Plan data: MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN plan

MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision

401k Sponsoring company profile

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

Company Name: MILLER HOLDINGS, INC

Employer identification number (EIN): 753098510

NAIC Classification: 321900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01 KEN WALTER 2023-11-29 KEN WALTER 2023-11-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-07-01	KEN WALTER	2023-11-29	KEN WALTER	2023-11-29

Plan Statistics for MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 187
Total of all active and inactive participants 2022-07-01 187

Measure	Date	Value
2022: MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	187
Total of all active and inactive participants	2022-07-01	187

Form 5500 Responses for MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN

2022: MILLER HOLDINGS, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	First time form 5500 has been submitted	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SANFORD HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95683 )

Policy contract number

HP040910

Policy instance

Insurance contract or identification number	HP040910
Number of Individuals Covered	144
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $31,650
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $771,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,650

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

30912-67

Policy instance

Insurance contract or identification number	30912-67
Number of Individuals Covered	182
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,997
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,997

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

Policy contract number

924627

Policy instance

Insurance contract or identification number	924627
Number of Individuals Covered	187
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $6,833
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,833

Potentially related plans

MILLER HOLDINGS, INC 401(K) P/S PLAN [EIN = 474202964]

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Company Name:	MILLER HOLDINGS, INC
Employer identification number (EIN):	753098510
NAIC Classification:	321900