401k Plan data: PHOENIX HEALTH & WELFARE PLAN plan

PHOENIX HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	PHOENIX HEALTH & WELFARE PLAN
Plan identification number	506

PHOENIX HEALTH & 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) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

PHOENIX NUCLEAR HOLDING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: PHOENIX NUCLEAR HOLDING COMPANY

Employer identification number (EIN): 822364425

NAIC Classification: 331310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHOENIX HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2021-04-01 DAVID BAILEY 2022-12-07
506 2021-04-01 SUE PRECHEL 2024-09-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
506	2021-04-01	DAVID BAILEY	2022-12-07
506	2021-04-01	SUE PRECHEL	2024-09-17

Plan Statistics for PHOENIX HEALTH & WELFARE PLAN

401k plan membership statisitcs for PHOENIX HEALTH & WELFARE PLAN

Measure Date Value
2021: PHOENIX HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-04-01 113
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 113
Number of retired or separated participants receiving benefits 2021-04-01 0
Number of other retired or separated participants entitled to future benefits 2021-04-01 0
Total of all active and inactive participants 2021-04-01 113
Number of employers contributing to the scheme 2021-04-01 0

Measure	Date	Value
2021: PHOENIX HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-04-01	113
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	113
Number of retired or separated participants receiving benefits	2021-04-01	0
Number of other retired or separated participants entitled to future benefits	2021-04-01	0
Total of all active and inactive participants	2021-04-01	113
Number of employers contributing to the scheme	2021-04-01	0

Form 5500 Responses for PHOENIX HEALTH & WELFARE PLAN

2021: PHOENIX HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	First time form 5500 has been submitted	Yes
2021-04-01	Submission has been amended	Yes
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITY HEALTH PLANS INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95796 )

Policy contract number

900611

Policy instance

Insurance contract or identification number	900611
Number of Individuals Covered	225
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $21,118
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $849,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,118
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5951743

Policy instance

Insurance contract or identification number	5951743
Number of Individuals Covered	358
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $5,935
Total amount of fees paid to insurance company	USD $74
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,536
Amount paid for insurance broker fees	74
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

WYSSTA INSURANCE COMPANY INC. (National Association of Insurance Commissioners NAIC id number: 12352 )

Policy contract number

42421 00000

Policy instance

Insurance contract or identification number	42421 00000
Number of Individuals Covered	81
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $782
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $782
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BQ9V

Policy instance

Insurance contract or identification number	GLUG0BQ9V
Number of Individuals Covered	113
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $8,156
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $68,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,156
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	PHOENIX NUCLEAR HOLDING COMPANY
Employer identification number (EIN):	822364425
NAIC Classification:	331310