401k Plan data: I2M BENEFIT PLAN plan

I2M BENEFIT PLAN 401k Plan overview

Plan Name	I2M BENEFIT PLAN
Plan identification number	501

I2M BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

CRESTWOOD MEMBRANES INC T/A I2M has sponsored the creation of one or more 401k plans.

Company Name: CRESTWOOD MEMBRANES INC T/A I2M

Employer identification number (EIN): 450700022

NAIC Classification: 423300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan I2M BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-08-01
501 2021-08-01 CHRISTOPHER HACKETT 2023-05-15
501 2020-08-01 CHRISTOPHER HACKETT 2022-05-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-08-01
501	2021-08-01	CHRISTOPHER HACKETT	2023-05-15
501	2020-08-01	CHRISTOPHER HACKETT	2022-05-13

Plan Statistics for I2M BENEFIT PLAN

401k plan membership statisitcs for I2M BENEFIT PLAN

Measure Date Value
2022: I2M BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-08-01 122
Total number of active participants reported on line 7a of the Form 5500 2022-08-01 147
Number of retired or separated participants receiving benefits 2022-08-01 1
Number of other retired or separated participants entitled to future benefits 2022-08-01 0
Total of all active and inactive participants 2022-08-01 148
2021: I2M BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-08-01 131
Total number of active participants reported on line 7a of the Form 5500 2021-08-01 129
Total of all active and inactive participants 2021-08-01 129
2020: I2M BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-08-01 122
Total number of active participants reported on line 7a of the Form 5500 2020-08-01 131
Total of all active and inactive participants 2020-08-01 131

Measure	Date	Value
2022: I2M BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-08-01	122
Total number of active participants reported on line 7a of the Form 5500	2022-08-01	147
Number of retired or separated participants receiving benefits	2022-08-01	1
Number of other retired or separated participants entitled to future benefits	2022-08-01	0
Total of all active and inactive participants	2022-08-01	148
2021: I2M BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-08-01	131
Total number of active participants reported on line 7a of the Form 5500	2021-08-01	129
Total of all active and inactive participants	2021-08-01	129
2020: I2M BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-08-01	122
Total number of active participants reported on line 7a of the Form 5500	2020-08-01	131
Total of all active and inactive participants	2020-08-01	131

Form 5500 Responses for I2M BENEFIT PLAN

2022: I2M BENEFIT PLAN 2022 form 5500 responses
2022-08-01	Type of plan entity	Single employer plan
2022-08-01	Submission has been amended	No
2022-08-01	This submission is the final filing	No
2022-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-08-01	Plan is a collectively bargained plan	No
2022-08-01	Plan funding arrangement – Insurance	Yes
2022-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-08-01	Plan benefit arrangement – Insurance	Yes
2022-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: I2M BENEFIT PLAN 2021 form 5500 responses
2021-08-01	Type of plan entity	Single employer plan
2021-08-01	Plan funding arrangement – Insurance	Yes
2021-08-01	Plan benefit arrangement – Insurance	Yes
2020: I2M BENEFIT PLAN 2020 form 5500 responses
2020-08-01	Type of plan entity	Single employer plan
2020-08-01	Plan funding arrangement – Insurance	Yes
2020-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504546

Policy instance

Insurance contract or identification number	00504546
Number of Individuals Covered	151
Insurance policy start date	2022-08-01
Insurance policy end date	2023-07-31
Total amount of commissions paid to insurance broker	USD $15,132
Total amount of fees paid to insurance company	USD $1,755
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	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY
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 $77,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,132
Amount paid for insurance broker fees	1755
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

407784

Policy instance

Insurance contract or identification number	407784
Number of Individuals Covered	145
Insurance policy start date	2022-08-01
Insurance policy end date	2023-07-31
Total amount of commissions paid to insurance broker	USD $65,328
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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 $435,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,328
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504546

Policy instance

Insurance contract or identification number	00504546
Number of Individuals Covered	129
Insurance policy start date	2021-08-01
Insurance policy end date	2022-07-31
Total amount of commissions paid to insurance broker	USD $11,886
Total amount of fees paid to insurance company	USD $2,666
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $62,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,886
Amount paid for insurance broker fees	2666
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

407784

Policy instance

Insurance contract or identification number	407784
Number of Individuals Covered	126
Insurance policy end date	2022-07-31
Total amount of commissions paid to insurance broker	USD $45,061
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $300,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,061

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

Policy instance

Number of Individuals Covered	144
Insurance policy start date	2020-08-01
Insurance policy end date	2021-07-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504546

Policy instance

Insurance contract or identification number	00504546
Number of Individuals Covered	131
Insurance policy start date	2020-08-01
Insurance policy end date	2021-07-31
Total amount of commissions paid to insurance broker	USD $12,057
Total amount of fees paid to insurance company	USD $816
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $89,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,347
Amount paid for insurance broker fees	816
Insurance broker organization code?	3

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Company Name:	CRESTWOOD MEMBRANES INC T/A I2M
Employer identification number (EIN):	450700022
NAIC Classification:	423300