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RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameRUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN
Plan identification number 501

RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

RUBICON OILFIELD INTERNATIONAL has sponsored the creation of one or more 401k plans.

Company Name:RUBICON OILFIELD INTERNATIONAL
Employer identification number (EIN):981302708
NAIC Classification:324190

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-03-01DAWN HARRINGTON2021-11-02
5012020-03-01DAWN HARRINGTON2021-10-13
5012019-03-01THOMAS HOLLOWAY2020-09-17
5012018-03-01CORY ROCLAWSKI2019-09-03
5012017-03-01

Plan Statistics for RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN

401k plan membership statisitcs for RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN

Measure Date Value
2021: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-03-01329
Total number of active participants reported on line 7a of the Form 55002021-03-010
Number of retired or separated participants receiving benefits2021-03-010
Number of other retired or separated participants entitled to future benefits2021-03-010
Total of all active and inactive participants2021-03-010
Number of employers contributing to the scheme2021-03-010
2020: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-03-01412
Total number of active participants reported on line 7a of the Form 55002020-03-01329
Number of retired or separated participants receiving benefits2020-03-010
Number of other retired or separated participants entitled to future benefits2020-03-010
Total of all active and inactive participants2020-03-01329
Number of employers contributing to the scheme2020-03-010
2019: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-01410
Total number of active participants reported on line 7a of the Form 55002019-03-01384
Number of retired or separated participants receiving benefits2019-03-016
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-01390
Number of employers contributing to the scheme2019-03-010
2018: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-01363
Total number of active participants reported on line 7a of the Form 55002018-03-01399
Number of retired or separated participants receiving benefits2018-03-012
Number of other retired or separated participants entitled to future benefits2018-03-010
Total of all active and inactive participants2018-03-01401
Number of employers contributing to the scheme2018-03-010
2017: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-01318
Total number of active participants reported on line 7a of the Form 55002017-03-01379
Number of retired or separated participants receiving benefits2017-03-010
Number of other retired or separated participants entitled to future benefits2017-03-010
Total of all active and inactive participants2017-03-01379

Form 5500 Responses for RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN

2021: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01This submission is the final filingYes
2021-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan funding arrangement – General assets of the sponsorYes
2021-03-01Plan benefit arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – General assets of the sponsorYes
2020: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan funding arrangement – General assets of the sponsorYes
2020-03-01Plan benefit arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – General assets of the sponsorYes
2019: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan funding arrangement – General assets of the sponsorYes
2019-03-01Plan benefit arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – General assets of the sponsorYes
2018: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan funding arrangement – General assets of the sponsorYes
2018-03-01Plan benefit arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – General assets of the sponsorYes
2017: RUBICON OILFIELD INTERNATIONAL HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01First time form 5500 has been submittedYes
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan funding arrangement – General assets of the sponsorYes
2017-03-01Plan benefit arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number891107G
Policy instance 3
Insurance contract or identification number891107G
Number of Individuals Covered209
Insurance policy start date2020-08-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $7,115
Total amount of fees paid to insurance companyUSD $22,781
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $70,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,115
Amount paid for insurance broker fees22781
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number625388
Policy instance 2
Insurance contract or identification number625388
Number of Individuals Covered347
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $106,012
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,211,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees106012
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEE INCENTIVE COMPENSATION
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number10-053141
Policy instance 1
Insurance contract or identification number10-053141
Number of Individuals Covered409
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $28,484
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $284,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,484
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number423940
Policy instance 4
Insurance contract or identification number423940
Number of Individuals Covered225
Insurance policy start date2020-04-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $27,870
Total amount of fees paid to insurance companyUSD $3,252
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $139,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,870
Amount paid for insurance broker fees3252
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number423940
Policy instance 3
Insurance contract or identification number423940
Number of Individuals Covered383
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $69,186
Total amount of fees paid to insurance companyUSD $7,611
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $461,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,186
Amount paid for insurance broker fees7611
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number625388
Policy instance 2
Insurance contract or identification number625388
Number of Individuals Covered653
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $39,840
Total amount of fees paid to insurance companyUSD $183,213
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,516,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,840
Amount paid for insurance broker fees183213
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5950283
Policy instance 1
Insurance contract or identification number5950283
Number of Individuals Covered1374
Insurance policy start date2020-03-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $436
Total amount of fees paid to insurance companyUSD $162
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $436
Amount paid for insurance broker fees162
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number423940
Policy instance 3
Insurance contract or identification number423940
Number of Individuals Covered437
Insurance policy start date2019-03-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $7,418
Total amount of fees paid to insurance companyUSD $371
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $49,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,418
Amount paid for insurance broker fees371
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number625388
Policy instance 2
Insurance contract or identification number625388
Number of Individuals Covered702
Insurance policy start date2019-03-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5950283
Policy instance 1
Insurance contract or identification number5950283
Number of Individuals Covered1380
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $8,194
Total amount of fees paid to insurance companyUSD $1,066
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,194
Amount paid for insurance broker fees1066
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number423940
Policy instance 3
Insurance contract or identification number423940
Number of Individuals Covered386
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $66,993
Total amount of fees paid to insurance companyUSD $11,099
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $441,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $66,993
Amount paid for insurance broker fees11099
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI SOUTHWEST, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10104791001
Policy instance 2
Insurance contract or identification number10104791001
Number of Individuals Covered802
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $4,031
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,031
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number208922
Policy instance 1
Insurance contract or identification number208922
Number of Individuals Covered920
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $261,498
Total amount of fees paid to insurance companyUSD $16
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,365,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $261,498
Amount paid for insurance broker fees16
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI SOUTHWEST, INC.

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