401k Plan data: MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN plan

MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	502

MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT 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) Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

MEYERS BROS. TRUCKING has sponsored the creation of one or more 401k plans.

Company Name: MEYERS BROS. TRUCKING

Employer identification number (EIN): 510476478

NAIC Classification: 484120
NAIC Description: General Freight Trucking, Long-Distance

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-01-01 RON FREESE 2022-07-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-01-01	RON FREESE	2022-07-19

Plan Statistics for MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2021: MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 60
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 60
Number of employers contributing to the scheme 2021-01-01 0

Measure	Date	Value
2021: MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	60
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	60
Number of employers contributing to the scheme	2021-01-01	0

Form 5500 Responses for MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN

2021: MEYERS BROS. TRUCKING, LLC HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

09L2257

Policy instance

Insurance contract or identification number	09L2257
Number of Individuals Covered	108
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $19,654
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $768,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,654
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

W42699

Policy instance

Insurance contract or identification number	W42699
Number of Individuals Covered	60
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,666
Total amount of fees paid to insurance company	USD $498
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $45,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,666
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

E3M90

Policy instance

Insurance contract or identification number	E3M90
Number of Individuals Covered	9
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,241
Total amount of fees paid to insurance company	USD $65
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $11,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $702
Amount paid for insurance broker fees	31
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	MEYERS BROS. TRUCKING
Employer identification number (EIN):	510476478
NAIC Classification:	484120
NAIC Description:	General Freight Trucking, Long-Distance