401k Plan data: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN plan

GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	GREAT DANE PETROLEUM WELFARE BENEFIT PLAN
Plan identification number	501

GREAT DANE PETROLEUM WELFARE BENEFIT 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) Other welfare benefit cover

401k Sponsoring company profile

GREAT DANE PETROLEUM CONTRACTORS, INC. has sponsored the creation of one or more 401k plans.

Company Name: GREAT DANE PETROLEUM CONTRACTORS, INC.

Employer identification number (EIN): 593550435

NAIC Classification: 236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREAT DANE PETROLEUM WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-04-01
501 2022-04-01 CHRIS O'CONNELL
501 2021-04-01
501 2021-04-01 DANIELLE WATKINS
501 2020-04-01
501 2019-04-01

Plan Statistics for GREAT DANE PETROLEUM WELFARE BENEFIT PLAN

401k plan membership statisitcs for GREAT DANE PETROLEUM WELFARE BENEFIT PLAN

Measure Date Value
2022: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-04-01 115
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 0
Number of retired or separated participants receiving benefits 2022-04-01 0
Number of other retired or separated participants entitled to future benefits 2022-04-01 0
Total of all active and inactive participants 2022-04-01 0
2021: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-04-01 138
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 115
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 2021-04-01 115
2020: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-04-01 151
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 138
Number of retired or separated participants receiving benefits 2020-04-01 0
Number of other retired or separated participants entitled to future benefits 2020-04-01 0
Total of all active and inactive participants 2020-04-01 138
2019: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-04-01 138
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 147
Number of retired or separated participants receiving benefits 2019-04-01 1
Number of other retired or separated participants entitled to future benefits 2019-04-01 3
Total of all active and inactive participants 2019-04-01 151

Measure	Date	Value
2022: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	115
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	0
Number of retired or separated participants receiving benefits	2022-04-01	0
Number of other retired or separated participants entitled to future benefits	2022-04-01	0
Total of all active and inactive participants	2022-04-01	0
2021: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-04-01	138
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	115
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	115
2020: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-04-01	151
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	138
Number of retired or separated participants receiving benefits	2020-04-01	0
Number of other retired or separated participants entitled to future benefits	2020-04-01	0
Total of all active and inactive participants	2020-04-01	138
2019: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-04-01	138
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	147
Number of retired or separated participants receiving benefits	2019-04-01	1
Number of other retired or separated participants entitled to future benefits	2019-04-01	3
Total of all active and inactive participants	2019-04-01	151

Form 5500 Responses for GREAT DANE PETROLEUM WELFARE BENEFIT PLAN

2022: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Submission has been amended	No
2022-04-01	This submission is the final filing	Yes
2022-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-04-01	Plan is a collectively bargained plan	No
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2021: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Submission has been amended	No
2021-04-01	This submission is the final filing	No
2021-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-04-01	Plan is a collectively bargained plan	No
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2020: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Submission has been amended	No
2020-04-01	This submission is the final filing	No
2020-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-04-01	Plan is a collectively bargained plan	No
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2019: GREAT DANE PETROLEUM WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	First time form 5500 has been submitted	Yes
2019-04-01	Submission has been amended	No
2019-04-01	This submission is the final filing	No
2019-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-04-01	Plan is a collectively bargained plan	No
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

G000BJ8H

Policy instance

Insurance contract or identification number	G000BJ8H
Number of Individuals Covered	44
Insurance policy start date	2022-04-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,897
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $38,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00625649

Policy instance

Insurance contract or identification number	00625649
Number of Individuals Covered	137
Insurance policy start date	2022-04-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,645
Total amount of fees paid to insurance company	USD $35,015
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $922,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

GVTL0BJ8H

Policy instance

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

Policy contract number

GUPR0BJ8H

Policy instance

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

Policy contract number

GUDB0BJ8H

Policy instance

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

Policy contract number

GUC 0BJ8H

Policy instance

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

Policy contract number

GLLV0BJ8H

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00625649

Policy instance

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

Policy contract number

GVTL0BJ8H

Policy instance

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

Policy contract number

GUPR0BJ8H

Policy instance

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

Policy contract number

GUDB0BJ8H

Policy instance

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

Policy contract number

GUC 0BJ8H

Policy instance

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

Policy contract number

GLLV0BJ8H

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00625649

Policy instance

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Company Name:	GREAT DANE PETROLEUM CONTRACTORS, INC.
Employer identification number (EIN):	593550435
NAIC Classification:	236110

Plan id#	Filing Submission Date	Name of Administrator
501	2022-04-01
501	2022-04-01	CHRIS O'CONNELL
501	2021-04-01
501	2021-04-01	DANIELLE WATKINS
501	2020-04-01
501	2019-04-01