401k Plan data: Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL plan

Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL 401k Plan overview

Plan Name	Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL
Plan identification number	503

Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL 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

Q2 ARTIFICIAL LIFT SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name: Q2 ARTIFICIAL LIFT SERVICES, LLC

Employer identification number (EIN): 371848758

NAIC Classification: 532400
NAIC Description: Commercial and Industrial Machinery and Equipment Rental and Leasing

Additional information about Q2 ARTIFICIAL LIFT SERVICES, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2017-01-25

Company Identification Number: 0802634593

Legal Registered Office Address: 7883 EDGAR INDUSTRIAL WAY

RED DEER
United States of America (USA)

More information about Q2 ARTIFICIAL LIFT SERVICES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2019-12-01
503 2019-12-01

Plan Statistics for Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL

401k plan membership statisitcs for Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL

Measure Date Value
2019: Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL 2019 401k membership
Total participants, beginning-of-year 2019-12-01 134
Total number of active participants reported on line 7a of the Form 5500 2019-12-01 97
Total of all active and inactive participants 2019-12-01 97
Number of retired or separated participants receiving benefits 2019-12-01 0
Number of other retired or separated participants entitled to future benefits 2019-12-01 0

Measure	Date	Value
2019: Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL 2019 401k membership
Total participants, beginning-of-year	2019-12-01	134
Total number of active participants reported on line 7a of the Form 5500	2019-12-01	97
Total of all active and inactive participants	2019-12-01	97
Number of retired or separated participants receiving benefits	2019-12-01	0
Number of other retired or separated participants entitled to future benefits	2019-12-01	0

Form 5500 Responses for Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL

2019: Q2 ARTIFICIAL LIFT SERVICES LLC WELFARE BENEFIT PL 2019 form 5500 responses
2019-12-01	Type of plan entity	Single employer plan
2019-12-01	Submission has been amended	No
2019-12-01	This submission is the final filing	No
2019-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-12-01	Plan is a collectively bargained plan	No
2019-12-01	Plan funding arrangement – Insurance	Yes
2019-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 75841 )

Policy contract number

75841

Policy instance

Insurance contract or identification number	75841
Number of Individuals Covered	218
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $85,902
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	Yes
Dental Insurance Welfare Benefit	Yes
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 $1,484,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GFY75841

Policy instance

Insurance contract or identification number	GFY75841
Number of Individuals Covered	132
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $12,866
Total amount of fees paid to insurance company	USD $3,784
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	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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 $94,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	Q2 ARTIFICIAL LIFT SERVICES, LLC
Employer identification number (EIN):	371848758
NAIC Classification:	532400
NAIC Description:	Commercial and Industrial Machinery and Equipment Rental and Leasing

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2017-01-25
Company Identification Number:	0802634593
Legal Registered Office Address:	7883 EDGAR INDUSTRIAL WAY RED DEER United States of America (USA)