401k Plan data: HF SINCLAIR GROUP WELFARE BENEFITS PLAN plan

HF SINCLAIR GROUP WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	HF SINCLAIR GROUP WELFARE BENEFITS PLAN
Plan identification number	510

HF SINCLAIR GROUP WELFARE BENEFITS PLAN 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) Other welfare benefit cover

401k Sponsoring company profile

HF SINCLAIR has sponsored the creation of one or more 401k plans.

Company Name: HF SINCLAIR

Employer identification number (EIN): 872092143

NAIC Classification: 324110
NAIC Description: Petroleum Refineries

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HF SINCLAIR GROUP WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2022-01-01 REBECCA EADS 2023-06-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
510	2022-01-01	REBECCA EADS	2023-06-08

Plan Statistics for HF SINCLAIR GROUP WELFARE BENEFITS PLAN

401k plan membership statisitcs for HF SINCLAIR GROUP WELFARE BENEFITS PLAN

Measure Date Value
2022: HF SINCLAIR GROUP WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 3,305
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 4,220
Number of retired or separated participants receiving benefits 2022-01-01 119
Number of other retired or separated participants entitled to future benefits 2022-01-01 77
Total of all active and inactive participants 2022-01-01 4,416
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: HF SINCLAIR GROUP WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	3,305
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	4,220
Number of retired or separated participants receiving benefits	2022-01-01	119
Number of other retired or separated participants entitled to future benefits	2022-01-01	77
Total of all active and inactive participants	2022-01-01	4,416
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for HF SINCLAIR GROUP WELFARE BENEFITS PLAN

2022: HF SINCLAIR GROUP WELFARE BENEFITS PLAN 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

70411

Policy instance

Insurance contract or identification number	70411
Number of Individuals Covered	6776
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $200,000
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $5,852,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	200000
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12296869

Policy instance

Insurance contract or identification number	12296869
Number of Individuals Covered	3349
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $37,837
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $756,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,837
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

HOLLYFRONTIER

Policy instance

Insurance contract or identification number	HOLLYFRONTIER
Number of Individuals Covered	4347
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $57,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

60021599

Policy instance

Insurance contract or identification number	60021599
Number of Individuals Covered	819
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $16,020
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,034,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,020
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

99060082

Policy instance

Insurance contract or identification number	99060082
Number of Individuals Covered	4220
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $97,504
Health Insurance Welfare Benefit	No
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
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT,ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $650,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	97504
Additional information about fees paid to insurance broker	STRAIGHT FEE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

HC960332

Policy instance

Insurance contract or identification number	HC960332
Number of Individuals Covered	4220
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
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
Other welfare benefits provided	HOSPITAL,CRITICAL ILLNESS,ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $991,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	HF SINCLAIR
Employer identification number (EIN):	872092143
NAIC Classification:	324110
NAIC Description:	Petroleum Refineries