401k Plan data: FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN plan

FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN 401k Plan overview

Plan Name	FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN
Plan identification number	508

FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

FRISTAM PUMPS USA, LIMITED PARTNERSHIP has sponsored the creation of one or more 401k plans.

Company Name: FRISTAM PUMPS USA, LIMITED PARTNERSHIP

Employer identification number (EIN): 391263235

NAIC Classification: 333900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2021-10-01

Plan Statistics for FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN

401k plan membership statisitcs for FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN

Measure Date Value
2021: FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 100
Number of retired or separated participants receiving benefits 2021-10-01 1
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 101

Measure	Date	Value
2021: FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	100
Number of retired or separated participants receiving benefits	2021-10-01	1
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	101

Form 5500 Responses for FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN

2021: FRISTAM PUMPS USA, LIMITED PARTNERSHIP WRAP PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	First time form 5500 has been submitted	Yes
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITY HEALTH PLANS INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95796 )

Policy contract number

901223

Policy instance

Insurance contract or identification number	901223
Number of Individuals Covered	195
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $18,640
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,162,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,640
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10235081001

Policy instance

Insurance contract or identification number	10235081001
Number of Individuals Covered	131
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $667
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $667
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

61792

Policy instance

Insurance contract or identification number	61792
Number of Individuals Covered	103
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $9,274
Total amount of fees paid to insurance company	USD $17
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS, ACCIDENT, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $103,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,549
Insurance broker organization code?	3
Amount paid for insurance broker fees	17
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTER FEES

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Company Name:	FRISTAM PUMPS USA, LIMITED PARTNERSHIP
Employer identification number (EIN):	391263235
NAIC Classification:	333900