401k Plan data: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN plan

ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 401k Plan overview

Plan Name	ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN
Plan identification number	505

ROTO-MIX, LLC EMPLOYEE MEDICAL 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)
Other welfare benefit cover
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ROTO-MIX, LLC has sponsored the creation of one or more 401k plans.

Company Name: ROTO-MIX, LLC

Employer identification number (EIN): 203977759

NAIC Classification: 333100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2022-06-01 RODNEY R. NEIER 2024-03-04
505 2016-06-01
505 2015-06-01
505 2014-06-01 ROD NEIER 2018-10-23
505 2013-06-01 RODNEY R. NEIER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
505	2022-06-01	RODNEY R. NEIER	2024-03-04
505	2016-06-01
505	2015-06-01
505	2014-06-01	ROD NEIER	2018-10-23
505	2013-06-01	RODNEY R. NEIER

Plan Statistics for ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN

401k plan membership statisitcs for ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN

Measure Date Value
2022: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 116
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 116
Total of all active and inactive participants 2022-06-01 116
2016: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 100
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 89
Total of all active and inactive participants 2016-06-01 89
2015: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 106
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 100
Total of all active and inactive participants 2015-06-01 100
2014: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 101
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 106
Total of all active and inactive participants 2014-06-01 106
2013: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 103
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 101
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 101

Measure	Date	Value
2022: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	116
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	116
Total of all active and inactive participants	2022-06-01	116
2016: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	100
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	89
Total of all active and inactive participants	2016-06-01	89
2015: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	106
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	100
Total of all active and inactive participants	2015-06-01	100
2014: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	101
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	106
Total of all active and inactive participants	2014-06-01	106
2013: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	103
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	101
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	101

Form 5500 Responses for ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN

2022: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	Submission has been amended	No
2022-06-01	This submission is the final filing	No
2022-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-06-01	Plan is a collectively bargained plan	No
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: ROTO-MIX, LLC EMPLOYEE MEDICAL BENEFIT PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	First time form 5500 has been submitted	Yes
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

SY809

Policy instance

Insurance contract or identification number	SY809
Number of Individuals Covered	74
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $8,300
Total amount of fees paid to insurance company	USD $114
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	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	VOLUNTARY WORKSITE
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 $55,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,989
Amount paid for insurance broker fees	78
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

MEDICAL AIR SERVICES ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 62191 )

Policy contract number

B2BMLLC

Policy instance

Insurance contract or identification number	B2BMLLC
Number of Individuals Covered	88
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $9,181
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	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AMBULANCE TRANSPORT
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 $28,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,095
Insurance broker organization code?	3

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

Policy instance

Number of Individuals Covered	116
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $808
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	No
Long Term Disability Insurance Welfare Benefit	No
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 $4,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $808
Insurance broker organization code?	3

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Company Name:	ROTO-MIX, LLC
Employer identification number (EIN):	203977759
NAIC Classification:	333100