401k Plan data: SUMMIT CASING SERVICES HEALTH & WELFARE PLAN plan

SUMMIT CASING SERVICES HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	SUMMIT CASING SERVICES HEALTH & WELFARE PLAN
Plan identification number	501

SUMMIT CASING SERVICES 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)

401k Sponsoring company profile

SUMMIT CASING SERVICES, LLC DBA SUMMIT CASING EQUIPMENT has sponsored the creation of one or more 401k plans.

Company Name: SUMMIT CASING SERVICES, LLC DBA SUMMIT CASING EQUIPMENT

Employer identification number (EIN): 161714497

NAIC Classification: 333900

Additional information about SUMMIT CASING SERVICES, LLC DBA SUMMIT CASING EQUIPMENT

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2009-12-14

Company Identification Number: 0801204716

Legal Registered Office Address: 70 MECHANIC ST

FOXBORO
United States of America (USA)
02035

More information about SUMMIT CASING SERVICES, LLC DBA SUMMIT CASING EQUIPMENT

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUMMIT CASING SERVICES HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01

Plan Statistics for SUMMIT CASING SERVICES HEALTH & WELFARE PLAN

401k plan membership statisitcs for SUMMIT CASING SERVICES HEALTH & WELFARE PLAN

Measure Date Value
2022: SUMMIT CASING SERVICES HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 130
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 130

Measure	Date	Value
2022: SUMMIT CASING SERVICES HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	130
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	130

Form 5500 Responses for SUMMIT CASING SERVICES HEALTH & WELFARE PLAN

2022: SUMMIT CASING SERVICES HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VF026992

Policy instance

Insurance contract or identification number	VF026992
Number of Individuals Covered	74
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,101
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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 $11,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,101
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

329981

Policy instance

Insurance contract or identification number	329981
Number of Individuals Covered	137
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $41,710
Total amount of fees paid to insurance company	USD $5,258
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
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 $820,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $41,710
Amount paid for insurance broker fees	5258
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-017919-00

Policy instance

Insurance contract or identification number	01-017919-00
Number of Individuals Covered	134
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,680
Total amount of fees paid to insurance company	USD $1,217
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	AD&D
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 $43,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,680
Amount paid for insurance broker fees	1217
Additional information about fees paid to insurance broker	GROUP VOLUME BONUS
Insurance broker organization code?	3

HEALTHIEST YOU (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

HY2020

Policy instance

Insurance contract or identification number	HY2020
Number of Individuals Covered	130
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,064
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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 $13,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,064
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3

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Company Name:	SUMMIT CASING SERVICES, LLC DBA SUMMIT CASING EQUIPMENT
Employer identification number (EIN):	161714497
NAIC Classification:	333900

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2009-12-14
Company Identification Number:	0801204716
Legal Registered Office Address:	70 MECHANIC ST FOXBORO United States of America (USA) 02035