401k Plan data: HILLER MEASUREMENTS BENEFIT PLAN plan

HILLER MEASUREMENTS BENEFIT PLAN 401k Plan overview

Plan Name	HILLER MEASUREMENTS BENEFIT PLAN
Plan identification number	501

HILLER MEASUREMENTS BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) 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.

401k Sponsoring company profile

HILLER MEASUREMENTS INC has sponsored the creation of one or more 401k plans.

Company Name: HILLER MEASUREMENTS INC

Employer identification number (EIN): 275127046

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HILLER MEASUREMENTS BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-10-01 LAURA BECERRA 2023-02-13
501 2020-10-01 JEFF SMITH 2022-06-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-10-01	LAURA BECERRA	2023-02-13
501	2020-10-01	JEFF SMITH	2022-06-29

Plan Statistics for HILLER MEASUREMENTS BENEFIT PLAN

401k plan membership statisitcs for HILLER MEASUREMENTS BENEFIT PLAN

Measure Date Value
2021: HILLER MEASUREMENTS BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 114
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 65
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 6
Total of all active and inactive participants 2021-10-01 71
Number of employers contributing to the scheme 2021-10-01 0
2020: HILLER MEASUREMENTS BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 136
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 108
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 108
Number of employers contributing to the scheme 2020-10-01 0

Measure	Date	Value
2021: HILLER MEASUREMENTS BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	114
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	65
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	6
Total of all active and inactive participants	2021-10-01	71
Number of employers contributing to the scheme	2021-10-01	0
2020: HILLER MEASUREMENTS BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	136
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	108
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	108
Number of employers contributing to the scheme	2020-10-01	0

Form 5500 Responses for HILLER MEASUREMENTS BENEFIT PLAN

2021: HILLER MEASUREMENTS BENEFIT PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2020: HILLER MEASUREMENTS BENEFIT PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	First time form 5500 has been submitted	Yes
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

VF025850

Policy instance

Insurance contract or identification number	VF025850
Number of Individuals Covered	85
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $12,167
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $64,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,002
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

VF025850

Policy instance

Insurance contract or identification number	VF025850
Number of Individuals Covered	141
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $15,825
Total amount of fees paid to insurance company	USD $6,156
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $83,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,720
Amount paid for insurance broker fees	4397
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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Company Name:	HILLER MEASUREMENTS INC
Employer identification number (EIN):	275127046
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services