401k Plan data: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN plan

MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN
Plan identification number	501

MARE ISLAND DRY DOCK HEALTH AND WELFARE 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)

401k Sponsoring company profile

MARE ISLAND DRY DOCK LLC has sponsored the creation of one or more 401k plans.

Company Name: MARE ISLAND DRY DOCK LLC

Employer identification number (EIN): 460907554

NAIC Classification: 336610

Additional information about MARE ISLAND DRY DOCK LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5208746

More information about MARE ISLAND DRY DOCK LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-12-01 HARRY NICHOLSEN 2024-03-15
501 2021-12-01 HARRY NICHOLSEN 2023-05-11
501 2020-12-01 HARRY NICHOLSEN 2022-04-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-12-01	HARRY NICHOLSEN	2024-03-15
501	2021-12-01	HARRY NICHOLSEN	2023-05-11
501	2020-12-01	HARRY NICHOLSEN	2022-04-04

Plan Statistics for MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN

401k plan membership statisitcs for MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN

Measure Date Value
2022: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-12-01 123
Total number of active participants reported on line 7a of the Form 5500 2022-12-01 137
Number of retired or separated participants receiving benefits 2022-12-01 0
Number of other retired or separated participants entitled to future benefits 2022-12-01 0
Total of all active and inactive participants 2022-12-01 137
Number of employers contributing to the scheme 2022-12-01 0
2021: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-12-01 123
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 123
Number of retired or separated participants receiving benefits 2021-12-01 0
Number of other retired or separated participants entitled to future benefits 2021-12-01 0
Total of all active and inactive participants 2021-12-01 123
Number of employers contributing to the scheme 2021-12-01 0
2020: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-12-01 100
Total number of active participants reported on line 7a of the Form 5500 2020-12-01 123
Number of retired or separated participants receiving benefits 2020-12-01 0
Number of other retired or separated participants entitled to future benefits 2020-12-01 0
Total of all active and inactive participants 2020-12-01 123
Number of employers contributing to the scheme 2020-12-01 0

Measure	Date	Value
2022: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-12-01	123
Total number of active participants reported on line 7a of the Form 5500	2022-12-01	137
Number of retired or separated participants receiving benefits	2022-12-01	0
Number of other retired or separated participants entitled to future benefits	2022-12-01	0
Total of all active and inactive participants	2022-12-01	137
Number of employers contributing to the scheme	2022-12-01	0
2021: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	123
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	123
Number of retired or separated participants receiving benefits	2021-12-01	0
Number of other retired or separated participants entitled to future benefits	2021-12-01	0
Total of all active and inactive participants	2021-12-01	123
Number of employers contributing to the scheme	2021-12-01	0
2020: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-12-01	100
Total number of active participants reported on line 7a of the Form 5500	2020-12-01	123
Number of retired or separated participants receiving benefits	2020-12-01	0
Number of other retired or separated participants entitled to future benefits	2020-12-01	0
Total of all active and inactive participants	2020-12-01	123
Number of employers contributing to the scheme	2020-12-01	0

Form 5500 Responses for MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN

2022: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-12-01	Type of plan entity	Single employer plan
2022-12-01	Plan funding arrangement – Insurance	Yes
2022-12-01	Plan benefit arrangement – Insurance	Yes
2021: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2020: MARE ISLAND DRY DOCK HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-12-01	Type of plan entity	Single employer plan
2020-12-01	First time form 5500 has been submitted	Yes
2020-12-01	Plan funding arrangement – Insurance	Yes
2020-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

708242

Policy instance

Insurance contract or identification number	708242
Number of Individuals Covered	228
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $111,554
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,635,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $111,554
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

6525

Policy instance

Insurance contract or identification number	6525
Number of Individuals Covered	137
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $8,118
Total amount of fees paid to insurance company	USD $0
Dental 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
Welfare Benefit Premiums Paid to Carrier	USD $126,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,118
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30079471

Policy instance

Insurance contract or identification number	30079471
Number of Individuals Covered	60
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $839
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $721
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

708242

Policy instance

Insurance contract or identification number	708242
Number of Individuals Covered	214
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $93,377
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,547,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $93,377
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

6525

Policy instance

Insurance contract or identification number	6525
Number of Individuals Covered	137
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $6,698
Total amount of fees paid to insurance company	USD $2,400
Dental 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
Welfare Benefit Premiums Paid to Carrier	USD $105,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $6,698
Amount paid for insurance broker fees	2400
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30079471

Policy instance

Insurance contract or identification number	30079471
Number of Individuals Covered	52
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $691
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $614
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

708242

Policy instance

Insurance contract or identification number	708242
Number of Individuals Covered	91
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $88,612
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,266,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,612
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

6525

Policy instance

Insurance contract or identification number	6525
Number of Individuals Covered	123
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $6,158
Total amount of fees paid to insurance company	USD $0
Dental 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
Welfare Benefit Premiums Paid to Carrier	USD $105,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $6,158
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30079471

Policy instance

Insurance contract or identification number	30079471
Number of Individuals Covered	43
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $573
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $573
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

MARE ISLAND GOLF COURSE 401(K) PLAN [EIN = 204264948]

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Company Name:	MARE ISLAND DRY DOCK LLC
Employer identification number (EIN):	460907554
NAIC Classification:	336610

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5208746