401k Plan data: CLEANSPARK, INC. EMPLOYEE BENEFITS PLAN plan

CLEANSPARK, INC. EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	CLEANSPARK, INC. EMPLOYEE BENEFITS PLAN
Plan identification number	501

CLEANSPARK, INC. EMPLOYEE BENEFITS 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)

401k Sponsoring company profile

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

Company Name: CLEANSPARK, INC

Employer identification number (EIN): 870449945

NAIC Classification: 541512
NAIC Description: Computer Systems Design Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLEANSPARK, INC. EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-02-01 GARY VECCHIARELLI 2024-08-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-02-01	GARY VECCHIARELLI	2024-08-16

Form 5500 Responses for CLEANSPARK, INC. EMPLOYEE BENEFITS PLAN

2023: CLEANSPARK, INC. EMPLOYEE BENEFITS PLAN 2023 form 5500 responses
2023-02-01	Type of plan entity	Single employer plan
2023-02-01	First time form 5500 has been submitted	Yes
2023-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-02-01	Plan funding arrangement – Insurance	Yes
2023-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-02-01	Plan benefit arrangement – Insurance	Yes
2023-02-01	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

4F2087

Policy instance

Insurance contract or identification number	4F2087
Number of Individuals Covered	213
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $47,429
Total amount of fees paid to insurance company	USD $1,159
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,184,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1131804

Policy instance

Insurance contract or identification number	1131804
Number of Individuals Covered	218
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $27,650
Total amount of fees paid to insurance company	USD $9,511
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, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $146,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

207396

Policy instance

Insurance contract or identification number	207396
Number of Individuals Covered	50
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,261
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $10,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CLEANSPARK, INC
Employer identification number (EIN):	870449945
NAIC Classification:	541512
NAIC Description:	Computer Systems Design Services