401k Plan data: ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE plan

ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE 401k Plan overview

Plan Name	ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE
Plan identification number	501

ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ENSIGN ENGINEERING & LAND SURVEYING INC. has sponsored the creation of one or more 401k plans.

Company Name: ENSIGN ENGINEERING & LAND SURVEYING INC.

Employer identification number (EIN): 870443598

NAIC Classification: 541330
NAIC Description: Engineering Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 CATHY KENDALL 2023-04-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	CATHY KENDALL	2023-04-21

Plan Statistics for ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE

401k plan membership statisitcs for ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE

Measure Date Value
2022: ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE 2022 401k membership
Total participants, beginning-of-year 2022-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 112
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 112
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE 2022 401k membership
Total participants, beginning-of-year	2022-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	112
Number of retired or separated participants receiving benefits	2022-01-01	0
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	112
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE

2022: ENSIGN ENGINEERING & LAND SURVEYING, INC. HEALTH AND WELFARE 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

Insurance Providers Used on plan

MOTIVHEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 15743 )

Policy contract number

ENSIG01SN

Policy instance

Insurance contract or identification number	ENSIG01SN
Number of Individuals Covered	316
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $44,710
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
Commission paid to Insurance Broker	USD $44,710
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

51678

Policy instance

Insurance contract or identification number	51678
Number of Individuals Covered	28
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,887
Total amount of fees paid to insurance company	USD $81
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $11,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,358
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10213165

Policy instance

Insurance contract or identification number	10213165
Number of Individuals Covered	112
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,316
Total amount of fees paid to insurance company	USD $228
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $23,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,316
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BROKER BONUS

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

14043923

Policy instance

Insurance contract or identification number	14043923
Number of Individuals Covered	65
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,609
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $65,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $4,609
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

ENSIGN ENGINEERING, PC [EIN = 133750269]

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Company Name:	ENSIGN ENGINEERING & LAND SURVEYING INC.
Employer identification number (EIN):	870443598
NAIC Classification:	541330
NAIC Description:	Engineering Services