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FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 401k Plan overview

Plan NameFOX VALLEY METROLOGY LIFE AND DISABILITY PLAN
Plan identification number 502

FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

FOX VALLEY METROLOGY, LTD. has sponsored the creation of one or more 401k plans.

Company Name:FOX VALLEY METROLOGY, LTD.
Employer identification number (EIN):391836336
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-07-01ANDREA SCHAEFER2023-10-24
5022021-07-01ANDREA SCHAEFER2023-01-25
5022020-07-01ANDREA SCHAEFER2022-06-01
5022019-07-01ANDREA SCHAEFER2022-06-01
5022018-07-01ANDREA SCHAEFER2022-06-01
5022017-07-01ANDREA SCHAEFER2022-06-01
5022016-07-01ANDREA SCHAEFER2022-06-01
5022015-07-01ANDREA SCHAEFER2022-06-01

Plan Statistics for FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN

401k plan membership statisitcs for FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN

Measure Date Value
2022: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01167
Total number of active participants reported on line 7a of the Form 55002022-07-01184
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01184
Number of employers contributing to the scheme2022-07-010
2021: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01148
Total number of active participants reported on line 7a of the Form 55002021-07-01167
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01167
Number of employers contributing to the scheme2021-07-010
2020: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01139
Total number of active participants reported on line 7a of the Form 55002020-07-01148
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01148
Number of employers contributing to the scheme2020-07-010
2019: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01138
Total number of active participants reported on line 7a of the Form 55002019-07-01139
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01139
Number of employers contributing to the scheme2019-07-010
2018: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01127
Total number of active participants reported on line 7a of the Form 55002018-07-01138
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01138
Number of employers contributing to the scheme2018-07-010
2017: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01131
Total number of active participants reported on line 7a of the Form 55002017-07-01127
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01127
Number of employers contributing to the scheme2017-07-010
2016: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01113
Total number of active participants reported on line 7a of the Form 55002016-07-01131
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01131
Number of employers contributing to the scheme2016-07-010
2015: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-0110
Total number of active participants reported on line 7a of the Form 55002015-07-01113
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01113
Number of employers contributing to the scheme2015-07-010

Form 5500 Responses for FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN

2022: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: FOX VALLEY METROLOGY LIFE AND DISABILITY PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01First time form 5500 has been submittedYes
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number305138
Policy instance 1
Insurance contract or identification number305138
Number of Individuals Covered217
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $4,828
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $40,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,828
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number305138
Policy instance 1
Insurance contract or identification number305138
Number of Individuals Covered200
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $4,907
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $38,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $4,907
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number305138
Policy instance 1
Insurance contract or identification number305138
Number of Individuals Covered148
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $13,029
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $35,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,568
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number305138
Policy instance 1
Insurance contract or identification number305138
Number of Individuals Covered138
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $3,488
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $30,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,488
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number305138
Policy instance 1
Insurance contract or identification number305138
Number of Individuals Covered127
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $3,685
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $30,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,685
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AWFG
Policy instance 1
Insurance contract or identification numberGLUG0AWFG
Number of Individuals Covered128
Insurance policy start date2016-05-01
Insurance policy end date2017-04-30
Total amount of commissions paid to insurance brokerUSD $2,674
Total amount of fees paid to insurance companyUSD $1,935
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $26,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,674
Amount paid for insurance broker fees1161
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AWFG
Policy instance 2
Insurance contract or identification numberGLUG0AWFG
Number of Individuals Covered131
Insurance policy start date2017-05-01
Insurance policy end date2017-06-30
Total amount of commissions paid to insurance brokerUSD $469
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $469
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AWFG
Policy instance 1
Insurance contract or identification numberGLUG0AWFG
Number of Individuals Covered113
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $1,429
Total amount of fees paid to insurance companyUSD $560
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $24,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,429
Amount paid for insurance broker fees560
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3

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