401k Plan data: MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION plan

MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION 401k Plan overview

Plan Name	MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION
Plan identification number	501

MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover

401k Sponsoring company profile

MITTERNIGHT BOILER WORKS VEBA has sponsored the creation of one or more 401k plans.

Company Name: MITTERNIGHT BOILER WORKS VEBA

Employer identification number (EIN): 630844433

NAIC Classification: 525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01 LANCE COVAN 2020-12-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01	LANCE COVAN	2020-12-15

Plan Statistics for MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION

401k plan membership statisitcs for MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION

Measure Date Value
2019: MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION 2019 401k membership
Total participants, beginning-of-year 2019-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 25
Total of all active and inactive participants 2019-01-01 25

Measure	Date	Value
2019: MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION 2019 401k membership
Total participants, beginning-of-year	2019-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	25
Total of all active and inactive participants	2019-01-01	25

Financial Data on MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION

Measure	Date	Value
2019 : MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION 2019 401k financial data
Total income from all sources	2019-12-31	$296,469
Expenses. Total of all expenses incurred	2019-12-31	$296,469
Benefits paid (including direct rollovers)	2019-12-31	$296,469
Net income (gross income less expenses)	2019-12-31	$0
Total contributions received or receivable from employer(s)	2019-12-31	$296,469

Form 5500 Responses for MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION

2019: MITTERNIGHT BOILER WORKS INC VOLUNTARY EMPLOYEES BENEFICIAL ASSOCIATION 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50004424

Policy instance

Insurance contract or identification number	50004424
Number of Individuals Covered	10
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $99
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50004424

Policy instance

Insurance contract or identification number	50004424
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $251
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $125
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50004424

Policy instance

Insurance contract or identification number	50004424
Number of Individuals Covered	10
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $94
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51
Insurance broker organization code?	3

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

Policy contract number

11513

Policy instance

Insurance contract or identification number	11513
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,592
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,488
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

73804

Policy instance

Insurance contract or identification number	73804
Number of Individuals Covered	52
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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

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

Policy contract number

5U9830

Policy instance

Insurance contract or identification number	5U9830
Number of Individuals Covered	30
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,886
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $943
Insurance broker organization code?	3

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Company Name:	MITTERNIGHT BOILER WORKS VEBA
Employer identification number (EIN):	630844433
NAIC Classification:	525100
NAIC Description:	Insurance and Employee Benefit Funds