401k Plan data: WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN plan

WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN
Plan identification number	501

WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare 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

INNIO WAUKESHA GAS ENGINES, INC. has sponsored the creation of one or more 401k plans.

Company Name: INNIO WAUKESHA GAS ENGINES, INC.

Employer identification number (EIN): 403201571

NAIC Classification: 335310

Additional information about INNIO WAUKESHA GAS ENGINES, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1999-05-17

Company Identification Number: 0012652406

Legal Registered Office Address: 1101 W SAINT PAUL AVE STE 2

WAUKESHA
United States of America (USA)
53188

More information about INNIO WAUKESHA GAS ENGINES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-11-02 BETH LAST 2020-08-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-11-02	BETH LAST	2020-08-17

Plan Statistics for WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN

401k plan membership statisitcs for WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN

Measure Date Value
2018: WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-11-02 536
Total number of active participants reported on line 7a of the Form 5500 2018-11-02 492
Number of retired or separated participants receiving benefits 2018-11-02 61
Number of other retired or separated participants entitled to future benefits 2018-11-02 0
Total of all active and inactive participants 2018-11-02 553

Measure	Date	Value
2018: WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-11-02	536
Total number of active participants reported on line 7a of the Form 5500	2018-11-02	492
Number of retired or separated participants receiving benefits	2018-11-02	61
Number of other retired or separated participants entitled to future benefits	2018-11-02	0
Total of all active and inactive participants	2018-11-02	553

Form 5500 Responses for WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN

2018: WAUKESHA GAS ENGINES WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-11-02	Type of plan entity	Single employer plan
2018-11-02	First time form 5500 has been submitted	Yes
2018-11-02	Submission has been amended	No
2018-11-02	This submission is the final filing	No
2018-11-02	This return/report is a short plan year return/report (less than 12 months)	Yes
2018-11-02	Plan is a collectively bargained plan	No
2018-11-02	Plan funding arrangement – Insurance	Yes
2018-11-02	Plan funding arrangement – General assets of the sponsor	Yes
2018-11-02	Plan benefit arrangement – Insurance	Yes
2018-11-02	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

541481 0010DVIO

Policy instance

Insurance contract or identification number	541481 0010DVIO
Number of Individuals Covered	219
Insurance policy start date	2018-11-02
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $3,053
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $61,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,053
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5954525

Policy instance

Insurance contract or identification number	5954525
Number of Individuals Covered	1348
Insurance policy start date	2018-11-02
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $54,971
Total amount of fees paid to insurance company	USD $9,732
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,411,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,971
Amount paid for insurance broker fees	9732
Additional information about fees paid to insurance broker	$9,662: SUPPLEMENTAL COMPENSATION $70: NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0915378

Policy instance

Insurance contract or identification number	0915378
Number of Individuals Covered	273
Insurance policy start date	2018-11-02
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $86,634
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $2,803,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	86634
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

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

Policy contract number

30085611

Policy instance

Insurance contract or identification number	30085611
Number of Individuals Covered	90
Insurance policy start date	2018-11-02
Insurance policy end date	2019-10-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $37,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	INNIO WAUKESHA GAS ENGINES, INC.
Employer identification number (EIN):	403201571
NAIC Classification:	335310

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1999-05-17
Company Identification Number:	0012652406
Legal Registered Office Address:	1101 W SAINT PAUL AVE STE 2 WAUKESHA United States of America (USA) 53188