401k Plan data: ALTEK ELECTRONICS INC, HEALTH AND WELFARE PLAN plan

ALTEK ELECTRONICS INC, HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	ALTEK ELECTRONICS INC, HEALTH AND WELFARE PLAN
Plan identification number	504

ALTEK ELECTRONICS INC, HEALTH AND WELFARE 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

ALTEK ELECTRONICS, INC. has sponsored the creation of one or more 401k plans.

Company Name: ALTEK ELECTRONICS, INC.

Employer identification number (EIN): 200519095

NAIC Classification: 334410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALTEK ELECTRONICS INC, HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2023-05-01 MICHELLE HATTEYER 2024-10-23
504 2022-05-01 MICHELLE HATTEYER 2023-09-27
504 2021-05-01 MICHELLE HATTEYER 2022-09-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
504	2023-05-01	MICHELLE HATTEYER	2024-10-23
504	2022-05-01	MICHELLE HATTEYER	2023-09-27
504	2021-05-01	MICHELLE HATTEYER	2022-09-13

Form 5500 Responses for ALTEK ELECTRONICS INC, HEALTH AND WELFARE PLAN

2023: ALTEK ELECTRONICS INC, HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-05-01	Type of plan entity	Single employer plan
2023-05-01	Plan funding arrangement – Insurance	Yes
2023-05-01	Plan benefit arrangement – Insurance	Yes
2022: ALTEK ELECTRONICS INC, HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes
2021: ALTEK ELECTRONICS INC, HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	First time form 5500 has been submitted	Yes
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	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

924206

Policy instance

Insurance contract or identification number	924206
Number of Individuals Covered	205
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $1,149
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

636150

Policy instance

Insurance contract or identification number	636150
Number of Individuals Covered	150
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $52,120
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $560,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

165789

Policy instance

Insurance contract or identification number	165789
Number of Individuals Covered	88
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $8,670
Total amount of fees paid to insurance company	USD $889
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $34,554
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF CT, INC. (National Association of Insurance Commissioners NAIC id number: 15987 )

Policy contract number

4385

Policy instance

Insurance contract or identification number	4385
Number of Individuals Covered	198
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

165789

Policy instance

Insurance contract or identification number	165789
Number of Individuals Covered	177
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $2,500
Total amount of fees paid to insurance company	USD $991
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

924206

Policy instance

Insurance contract or identification number	924206
Number of Individuals Covered	196
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $854
Total amount of fees paid to insurance company	USD $5,148
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

636150

Policy instance

Insurance contract or identification number	636150
Number of Individuals Covered	130
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $45,296
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $496,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

165789

Policy instance

Insurance contract or identification number	165789
Number of Individuals Covered	63
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $5,752
Total amount of fees paid to insurance company	USD $702
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $24,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF CT, INC. (National Association of Insurance Commissioners NAIC id number: 15987 )

Policy contract number

4385

Policy instance

Insurance contract or identification number	4385
Number of Individuals Covered	190
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

165789

Policy instance

Insurance contract or identification number	165789
Number of Individuals Covered	152
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $1,778
Total amount of fees paid to insurance company	USD $774
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

165789

Policy instance

DELTA DENTAL OF CT, INC. (National Association of Insurance Commissioners NAIC id number: 15987 )

Policy contract number

4385

Policy instance

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

Policy contract number

924206

Policy instance

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Company Name:	ALTEK ELECTRONICS, INC.
Employer identification number (EIN):	200519095
NAIC Classification:	334410