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LISI OIL CO. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameLISI OIL CO. EMPLOYEE BENEFIT PLAN
Plan identification number 501

LISI OIL CO. EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Vision

401k Sponsoring company profile

LISI OIL CO. has sponsored the creation of one or more 401k plans.

Company Name:LISI OIL CO.
Employer identification number (EIN):231989650
NAIC Classification:454310
NAIC Description:Fuel Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LISI OIL CO. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01
5012020-12-01

Plan Statistics for LISI OIL CO. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for LISI OIL CO. EMPLOYEE BENEFIT PLAN

Measure Date Value
2021: LISI OIL CO. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-0116
Total number of active participants reported on line 7a of the Form 55002021-12-0115
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-0115
2020: LISI OIL CO. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-0120
Total number of active participants reported on line 7a of the Form 55002020-12-0116
Number of retired or separated participants receiving benefits2020-12-010
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-0116

Financial Data on LISI OIL CO. EMPLOYEE BENEFIT PLAN

Measure Date Value
2021 : LISI OIL CO. EMPLOYEE BENEFIT PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$33,720
Total plan liabilities at beginning of year2021-12-31$11,585
Total income from all sources2021-12-31$16,500
Expenses. Total of all expenses incurred2021-12-31$16,042
Benefits paid (including direct rollovers)2021-12-31$9,006
Total plan assets at end of year2021-12-31$40,527
Total plan assets at beginning of year2021-12-31$17,934
Value of fidelity bond covering the plan2021-12-31$25,000
Total contributions received or receivable from participants2021-12-31$1,700
Expenses. Other expenses not covered elsewhere2021-12-31$6,631
Other income received2021-12-31$17
Net income (gross income less expenses)2021-12-31$458
Net plan assets at end of year (total assets less liabilities)2021-12-31$6,807
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$6,349
Total contributions received or receivable from employer(s)2021-12-31$14,783
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$405
Total plan liabilities at end of year2021-11-30$11,585
Total income from all sources2021-11-30$230,488
Expenses. Total of all expenses incurred2021-11-30$224,139
Benefits paid (including direct rollovers)2021-11-30$129,250
Total plan assets at end of year2021-11-30$17,934
Value of fidelity bond covering the plan2021-11-30$25,000
Total contributions received or receivable from participants2021-11-30$24,800
Expenses. Other expenses not covered elsewhere2021-11-30$94,889
Other income received2021-11-30$361
Net income (gross income less expenses)2021-11-30$6,349
Net plan assets at end of year (total assets less liabilities)2021-11-30$6,349
Net plan assets at beginning of year (total assets less liabilities)2021-11-30$0
Total contributions received or receivable from employer(s)2021-11-30$205,327

Form 5500 Responses for LISI OIL CO. EMPLOYEE BENEFIT PLAN

2021: LISI OIL CO. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedNo
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-12-01Plan is a collectively bargained planNo
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – TrustYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement - TrustYes
2020: LISI OIL CO. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01First time form 5500 has been submittedYes
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30700040
Policy instance 1
Insurance contract or identification number30700040
Number of Individuals Covered15
Insurance policy start date2021-12-01
Insurance policy end date2021-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00531843
Policy instance 2
Insurance contract or identification number00531843
Number of Individuals Covered21
Insurance policy start date2021-12-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $68
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30700040
Policy instance 1
Insurance contract or identification number30700040
Number of Individuals Covered16
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $82,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00531843
Policy instance 2
Insurance contract or identification number00531843
Number of Individuals Covered20
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $38
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3

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