401k Plan data: LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN plan

LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN
Plan identification number	501

LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

LINDSEY MANUFACTURING CO. DBA LINDSEY SYSTEMS has sponsored the creation of one or more 401k plans.

Company Name: LINDSEY MANUFACTURING CO. DBA LINDSEY SYSTEMS

Employer identification number (EIN): 952225040

NAIC Classification: 332510
NAIC Description: Hardware Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-06-01 SAUL SILVA 2020-03-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-06-01	SAUL SILVA	2020-03-29

Plan Statistics for LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN

401k plan membership statisitcs for LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN

Measure Date Value
2018: LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-06-01 106
Total number of active participants reported on line 7a of the Form 5500 2018-06-01 125
Number of retired or separated participants receiving benefits 2018-06-01 0
Number of other retired or separated participants entitled to future benefits 2018-06-01 0
Total of all active and inactive participants 2018-06-01 125
Number of employers contributing to the scheme 2018-06-01 0

Measure	Date	Value
2018: LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	106
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	125
Number of retired or separated participants receiving benefits	2018-06-01	0
Number of other retired or separated participants entitled to future benefits	2018-06-01	0
Total of all active and inactive participants	2018-06-01	125
Number of employers contributing to the scheme	2018-06-01	0

Form 5500 Responses for LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN

2018: LINDSEY MANUFACTURING COMPANY WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	First time form 5500 has been submitted	Yes
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

W0066879

Policy instance

Insurance contract or identification number	W0066879
Number of Individuals Covered	125
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $34,990
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $583,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,990
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

O79-37516

Policy instance

Insurance contract or identification number	O79-37516
Number of Individuals Covered	145
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $6,195
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,195
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-009802

Policy instance

Insurance contract or identification number	136-009802
Number of Individuals Covered	213
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $1,118
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,118
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BCNX

Policy instance

Insurance contract or identification number	GLUG0BCNX
Number of Individuals Covered	106
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $2,898
Total amount of fees paid to insurance company	USD $278
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	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $19,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,898
Amount paid for insurance broker fees	278
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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Company Name:	LINDSEY MANUFACTURING CO. DBA LINDSEY SYSTEMS
Employer identification number (EIN):	952225040
NAIC Classification:	332510
NAIC Description:	Hardware Manufacturing