401k Plan data: SAC INCORPORATED HEALTH AND WELFARE PLAN plan

SAC INCORPORATED HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	SAC INCORPORATED HEALTH AND WELFARE PLAN
Plan identification number	501

SAC INCORPORATED HEALTH AND WELFARE 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) Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

SAC FASTENER CO has sponsored the creation of one or more 401k plans.

Company Name: SAC FASTENER CO

Employer identification number (EIN): 200362327

NAIC Classification: 423800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAC INCORPORATED HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 STEVE PADGETTE 2024-04-01
501 2022-01-01 ALEJANDRA HENDRIX 2023-07-20
501 2021-01-01 ROBYN SIMONS 2022-10-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	STEVE PADGETTE	2024-04-01
501	2022-01-01	ALEJANDRA HENDRIX	2023-07-20
501	2021-01-01	ROBYN SIMONS	2022-10-11

Form 5500 Responses for SAC INCORPORATED HEALTH AND WELFARE PLAN

2023: SAC INCORPORATED HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: SAC INCORPORATED HEALTH AND WELFARE 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 benefit arrangement – Insurance	Yes
2021: SAC INCORPORATED HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00617989

Policy instance

Insurance contract or identification number	G00617989
Number of Individuals Covered	88
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,359
Total amount of fees paid to insurance company	USD $1,083
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $36,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 )

Policy contract number

G1027858

Policy instance

Insurance contract or identification number	G1027858
Number of Individuals Covered	116
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $39,160
Total amount of fees paid to insurance company	USD $13,053
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,192,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

RCL003

Policy instance

Insurance contract or identification number	RCL003
Number of Individuals Covered	50
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,323
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $72,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 )

Policy contract number

10044741

Policy instance

Insurance contract or identification number	10044741
Number of Individuals Covered	202
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $34,979
Total amount of fees paid to insurance company	USD $1,230
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,288,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00617989

Policy instance

Insurance contract or identification number	G00617989
Number of Individuals Covered	106
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,241
Total amount of fees paid to insurance company	USD $1,274
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $42,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

RCL003

Policy instance

Insurance contract or identification number	RCL003
Number of Individuals Covered	77
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,615
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $43,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 )

Policy contract number

10044741

Policy instance

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00617989

Policy instance

DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

ACL2Q

Policy instance

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Company Name:	SAC FASTENER CO
Employer identification number (EIN):	200362327
NAIC Classification:	423800