401k Plan data: TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN plan

TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN 401k Plan overview

Plan Name	TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN
Plan identification number	501

TEKNON INFRASTRUCTURE SERVICES BENEFIT 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)

401k Sponsoring company profile

TEKNON INFRASTRUCTURE SERVICES LLC has sponsored the creation of one or more 401k plans.

Company Name: TEKNON INFRASTRUCTURE SERVICES LLC

Employer identification number (EIN): 911240081

NAIC Classification: 519100

Additional information about TEKNON INFRASTRUCTURE SERVICES LLC

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1984-02-10

Company Identification Number: 600525922

Legal Registered Office Address: 10675 WILLOWS RD NE

REDMOND
United States of America (USA)
980522530

More information about TEKNON INFRASTRUCTURE SERVICES LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-10-01 YUKO PHILLIPPS 2020-06-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-10-01	YUKO PHILLIPPS	2020-06-04

Plan Statistics for TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN

401k plan membership statisitcs for TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN

Measure Date Value
2018: TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 117
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 0
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 0
Total of all active and inactive participants 2018-10-01 0
Number of employers contributing to the scheme 2018-10-01 0

Measure	Date	Value
2018: TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	117
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	0
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	0
Total of all active and inactive participants	2018-10-01	0
Number of employers contributing to the scheme	2018-10-01	0

Form 5500 Responses for TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN

2018: TEKNON INFRASTRUCTURE SERVICES BENEFIT PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	First time form 5500 has been submitted	Yes
2018-10-01	This submission is the final filing	Yes
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

915319

Policy instance

Insurance contract or identification number	915319
Number of Individuals Covered	66
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $32,761
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $618,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,761
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30069474

Policy instance

Insurance contract or identification number	30069474
Number of Individuals Covered	47
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

50016728

Policy instance

Insurance contract or identification number	50016728
Number of Individuals Covered	68
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $430
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $225
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

13817

Policy instance

Insurance contract or identification number	13817
Number of Individuals Covered	98
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $2,829
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $2,829
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

159447

Policy instance

Insurance contract or identification number	159447
Number of Individuals Covered	27
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $3,550
Total amount of fees paid to insurance company	USD $213
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 $26,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,550
Amount paid for insurance broker fees	213
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

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Company Name:	TEKNON INFRASTRUCTURE SERVICES LLC
Employer identification number (EIN):	911240081
NAIC Classification:	519100

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1984-02-10
Company Identification Number:	600525922
Legal Registered Office Address:	10675 WILLOWS RD NE REDMOND United States of America (USA) 980522530