401k Plan data: ROCHESTER GAUGES HEALTH AND WELFARE PLAN

ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 401k Plan overview

Plan Name	ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL)
Plan identification number	501

ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

ROCHESTER SENSORS, LLC has sponsored the creation of one or more 401k plans.

Company Name: ROCHESTER SENSORS, LLC

Employer identification number (EIN): 750979821

NAIC Classification: 334500

Additional information about ROCHESTER SENSORS, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2018-05-23

Company Identification Number: 0803024105

Legal Registered Office Address: PO BOX 2368 ATTN: BEN PAREDES

COPPELL
United States of America (USA)
75019

More information about ROCHESTER SENSORS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL)

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 LIDIA LAZARO-ARROYO 2023-08-18
501 2021-01-01 ELI GONZALES 2022-10-11
501 2020-01-01 ELI GONZALES 2021-07-07
501 2019-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	LIDIA LAZARO-ARROYO	2023-08-18
501	2021-01-01	ELI GONZALES	2022-10-11
501	2020-01-01	ELI GONZALES	2021-07-07
501	2019-01-01

Plan Statistics for ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL)

401k plan membership statisitcs for ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL)

Measure Date Value
2022: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2022 401k membership
Total participants, beginning-of-year 2022-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 143
Number of retired or separated participants receiving benefits 2022-01-01 2
Number of other retired or separated participants entitled to future benefits 2022-01-01 8
Total of all active and inactive participants 2022-01-01 153
Number of employers contributing to the scheme 2022-01-01 0
2021: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2021 401k membership
Total participants, beginning-of-year 2021-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 172
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 2021-01-01 172
Number of employers contributing to the scheme 2021-01-01 0
2020: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2020 401k membership
Total participants, beginning-of-year 2020-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 153
Number of retired or separated participants receiving benefits 2020-01-01 2
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 155
Number of employers contributing to the scheme 2020-01-01 0
2019: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2019 401k membership
Total participants, beginning-of-year 2019-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 99
Number of retired or separated participants receiving benefits 2019-01-01 5
Number of other retired or separated participants entitled to future benefits 2019-01-01 104
Total of all active and inactive participants 2019-01-01 208

Measure	Date	Value
2022: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2022 401k membership
Total participants, beginning-of-year	2022-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	143
Number of retired or separated participants receiving benefits	2022-01-01	2
Number of other retired or separated participants entitled to future benefits	2022-01-01	8
Total of all active and inactive participants	2022-01-01	153
Number of employers contributing to the scheme	2022-01-01	0
2021: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2021 401k membership
Total participants, beginning-of-year	2021-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	172
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	172
Number of employers contributing to the scheme	2021-01-01	0
2020: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2020 401k membership
Total participants, beginning-of-year	2020-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	153
Number of retired or separated participants receiving benefits	2020-01-01	2
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	155
Number of employers contributing to the scheme	2020-01-01	0
2019: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2019 401k membership
Total participants, beginning-of-year	2019-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	99
Number of retired or separated participants receiving benefits	2019-01-01	5
Number of other retired or separated participants entitled to future benefits	2019-01-01	104
Total of all active and inactive participants	2019-01-01	208

Form 5500 Responses for ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL)

2022: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: ROCHESTER GAUGES HEALTH AND WELFARE PLAN - HEALTH (MEDICAL) 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

304943

Policy instance

Insurance contract or identification number	304943
Number of Individuals Covered	232
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $93,050
Total amount of fees paid to insurance company	USD $8,802
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,913,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $57,011
Amount paid for insurance broker fees	8802
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

304943

Policy instance

Insurance contract or identification number	304943
Number of Individuals Covered	302
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $90,048
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,874,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $90,048
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

916455

Policy instance

Insurance contract or identification number	916455
Number of Individuals Covered	268
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $15,641
Total amount of fees paid to insurance company	USD $29,151
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,751,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,641
Amount paid for insurance broker fees	27680
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

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

Policy contract number

0916455

Policy instance

Insurance contract or identification number	0916455
Number of Individuals Covered	237
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 $28,463
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	Yes
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 $1,450,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	28463
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

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Company Name:	ROCHESTER SENSORS, LLC
Employer identification number (EIN):	750979821
NAIC Classification:	334500

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2018-05-23
Company Identification Number:	0803024105
Legal Registered Office Address:	PO BOX 2368 ATTN: BEN PAREDES COPPELL United States of America (USA) 75019