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| Plan Name | BROTHERS PETROLEUM HEALTH AND WELFARE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MOUNTAIN EXPRESS OIL COMPANY |
| Employer identification number (EIN): | 582550873 |
| NAIC Classification: | 445120 |
| NAIC Description: | Convenience Stores |
Additional information about MOUNTAIN EXPRESS OIL COMPANY
| Jurisdiction of Incorporation: | Georgia Department of States Corporations Division |
| Incorporation Date: | 2000-06-13 |
| Company Identification Number: | 27140 |
| Legal Registered Office Address: |
5333 Bells Ferry Road Suite 201 Acworth United States of America (USA) 30102 |
More information about MOUNTAIN EXPRESS OIL COMPANY
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2022-01-01 | DOUGLAS BLANKENSHIP | 2023-07-26 |
| Measure | Date | Value |
|---|---|---|
| 2022: BROTHERS PETROLEUM HEALTH AND WELFARE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 421 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 29 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 30 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2022: BROTHERS PETROLEUM HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | First time form 5500 has been submitted | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 854351 | ||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||
| Policy contract number | R0565796 | ||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 10371851 | ||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||
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