December 1, 2020 The Summary Annual Report (SAR) provides a summary of the financial and insurance information reported in the annual reports for the Avaya-sponsored benefit plan for plan year beginning January 1, 2019 and ending December 31, 2019. The 2019 annual report for the below plan has recently been filed with the U.S. Department of Labor’s Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974, as amended (ERISA). You are receiving a copy of the SAR because you were a participant in the below listed plan in 2019. The SAR is informational only. No action is required. You have the right to request a hardcopy of the full annual reports, or any part of the annual report, by emailing Avaya HR Benefits at email@example.com or writing to Avaya Inc., 350 Mount Kemble Avenue, Morristown, NJ 07960. Avaya-sponsored benefits plan: Plan 552 – Avaya Inc. Health and Welfare Benefits Plan for Salaried Retirees
SUMMARY ANNUAL REPORT FOR THE AVAYA INC. HEALTH AND WELFARE BENEFITS PLAN FOR SALARIED RETIREES This is a summary of the annual report of The Avaya Inc. Health and Welfare Benefits Plan For Salaried Retirees, a life insurance plan (Employer Identification Number 22-3713430, Plan Number 552), for the plan year 01/01/2019 through 12/31/2019. The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA). Avaya Inc. has committed itself to pay certain claims incurred under the terms of the plan. Insurance Information The plan has insurance contracts with Metropolitan Life Insurance Company to pay certain Life insurance claims incurred under the terms of the plan. The total premiums paid for the plan year ending 12/31/2019 were $2,260,612. Because they are so called "experience-rated" contracts, the premium costs are affected by, among other things, the number and size of claims. Of the total insurance premiums paid for the plan year ending 12/31/2019, the premiums paid under such "experience-rated" contracts were $2,260,612 and the total of all benefit claims paid under these experience-rated contracts during the plan year was $2,084,358. Basic Financial Statement The value of plan assets, after subtracting liabilities of the plan, was $124,375,579 as of the end of plan year, compared to $106,649,093 as of the beginning of the plan year. During the plan year the plan experienced a change in its net assets of $17,726,486. This change includes unrealized appreciation and depreciation in the value of plan assets; that is, the difference between the value of the plan's assets at the end of the year and the value of the assets at the beginning of the year or the cost of assets acquired during the year. During the plan year, the plan had total income of $21,132,434 including employer contributions of $749,780, and earnings from investments of $20,382,654. Plan expenses were $3,405,948. These expenses included $905,246 in administrative expenses and $2,500,702 in benefits paid to participants and beneficiaries. Your Rights to Additional Information You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant's report. 2. Financial information and information on payments to service providers. 3. Assets held for investment. 4. Insurance information, including sales commissions paid by insurance carriers. 5. Information regarding any common or collective trusts, pooled separate accounts, master trusts or 103-12 investment entities in which the plan participates. To obtain a copy of the full annual report, or any part thereof, write to Avaya Inc., at 350 Mount Kemble Avenue, Morristown, NJ 07960. You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report. You also have the legally protected right to examine the annual report at the main office of the plan at Avaya Inc., 350 Mount Kemble Avenue, Morristown, NJ 07960, and at the U.S. Department of Labor in Washington, D.C., or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: Public Disclosure Room, Room N- 1513, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210.
Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average less than one minute per notice (approximately 3 hours and 11 minutes per plan). Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of the Chief Information Officer, Attention: Departmental Clearance Officer, 200 Constitution Avenue, N.W., Room N- 1301, Washington, DC 20210 or email DOL_PRA_PUBLIC@dol.gov and reference the OMB Control Number 1210-0040. OMB Control Number 1210-0040 (expires 06/30/2022)