401k Plan data: KOCH EMPLOYEE BENEFITS PLAN plan

KOCH EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	KOCH EMPLOYEE BENEFITS PLAN
Plan identification number	505

KOCH EMPLOYEE BENEFITS 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 Other welfare benefit cover

401k Sponsoring company profile

KOCH ENTERPRISES, INC. has sponsored the creation of one or more 401k plans.

Company Name: KOCH ENTERPRISES, INC.

Employer identification number (EIN): 350447300

NAIC Classification: 333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KOCH EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2024-01-01 GLEN MUEHLBAUER
505 2023-01-01
505 2023-01-01 GLEN MUEHLBAUER

Form 5500 Responses for KOCH EMPLOYEE BENEFITS PLAN

2023: KOCH EMPLOYEE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

946470

Policy instance

Insurance contract or identification number	946470
Number of Individuals Covered	2210
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $321,850
Total amount of fees paid to insurance company	USD $8,099
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $2,272,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30000092

Policy instance

Insurance contract or identification number	30000092
Number of Individuals Covered	1714
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,634
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $229,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

2004338

Policy instance

Insurance contract or identification number	2004338
Number of Individuals Covered	3512
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Other welfare benefits provided	ORGAN TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $213,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

Policy instance

Number of Individuals Covered	1892
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,052
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	KOCH ENTERPRISES, INC.
Employer identification number (EIN):	350447300
NAIC Classification:	333200

Plan id#	Filing Submission Date	Name of Administrator
505	2024-01-01	GLEN MUEHLBAUER
505	2023-01-01
505	2023-01-01	GLEN MUEHLBAUER