401k Plan data: THE MASON COMPANY BENEFIT PLAN plan

THE MASON COMPANY BENEFIT PLAN 401k Plan overview

Plan Name	THE MASON COMPANY BENEFIT PLAN
Plan identification number	505

THE MASON COMPANY BENEFIT 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

MIDMARK CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: MIDMARK CORPORATION

Employer identification number (EIN): 344269370

NAIC Classification: 339110

Additional information about MIDMARK CORPORATION

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1915-03-20

Company Identification Number: 35568

Legal Registered Office Address: 1300 EAST NINTH STREET
-
CLEVELAND
United States of America (USA)
44114

More information about MIDMARK CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE MASON COMPANY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2021-05-01 JARED POTTKOTTER 2022-07-18
505 2020-05-01 JARED D. POTTKOTTER 2021-11-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2021-05-01	JARED POTTKOTTER	2022-07-18
505	2020-05-01	JARED D. POTTKOTTER	2021-11-12

Plan Statistics for THE MASON COMPANY BENEFIT PLAN

401k plan membership statisitcs for THE MASON COMPANY BENEFIT PLAN

Measure Date Value
2021: THE MASON COMPANY BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-05-01 109
Total number of active participants reported on line 7a of the Form 5500 2021-05-01 0
Number of retired or separated participants receiving benefits 2021-05-01 0
Number of other retired or separated participants entitled to future benefits 2021-05-01 0
Total of all active and inactive participants 2021-05-01 0
Number of employers contributing to the scheme 2021-05-01 0
2020: THE MASON COMPANY BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-05-01 100
Total number of active participants reported on line 7a of the Form 5500 2020-05-01 109
Number of retired or separated participants receiving benefits 2020-05-01 0
Number of other retired or separated participants entitled to future benefits 2020-05-01 0
Total of all active and inactive participants 2020-05-01 109
Number of employers contributing to the scheme 2020-05-01 0

Measure	Date	Value
2021: THE MASON COMPANY BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-05-01	109
Total number of active participants reported on line 7a of the Form 5500	2021-05-01	0
Number of retired or separated participants receiving benefits	2021-05-01	0
Number of other retired or separated participants entitled to future benefits	2021-05-01	0
Total of all active and inactive participants	2021-05-01	0
Number of employers contributing to the scheme	2021-05-01	0
2020: THE MASON COMPANY BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-05-01	100
Total number of active participants reported on line 7a of the Form 5500	2020-05-01	109
Number of retired or separated participants receiving benefits	2020-05-01	0
Number of other retired or separated participants entitled to future benefits	2020-05-01	0
Total of all active and inactive participants	2020-05-01	109
Number of employers contributing to the scheme	2020-05-01	0

Form 5500 Responses for THE MASON COMPANY BENEFIT PLAN

2021: THE MASON COMPANY BENEFIT PLAN 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	This submission is the final filing	Yes
2021-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	Plan benefit arrangement – Insurance	Yes
2020: THE MASON COMPANY BENEFIT PLAN 2020 form 5500 responses
2020-05-01	Type of plan entity	Single employer plan
2020-05-01	First time form 5500 has been submitted	Yes
2020-05-01	Plan funding arrangement – Insurance	Yes
2020-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

519353

Policy instance

Insurance contract or identification number	519353
Number of Individuals Covered	72
Insurance policy start date	2021-05-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,507
Total amount of fees paid to insurance company	USD $6,269
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $505,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,507
Amount paid for insurance broker fees	6269
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

519353

Policy instance

Insurance contract or identification number	519353
Number of Individuals Covered	71
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $16,929
Total amount of fees paid to insurance company	USD $6,645
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $461,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,929
Amount paid for insurance broker fees	6645
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )

Policy contract number

519353

Policy instance

Insurance contract or identification number	519353
Number of Individuals Covered	109
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,633
Total amount of fees paid to insurance company	USD $1,221
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $24,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,633
Amount paid for insurance broker fees	1221
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

Potentially related plans

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Company Name:	MIDMARK CORPORATION
Employer identification number (EIN):	344269370
NAIC Classification:	339110

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1915-03-20
Company Identification Number:	35568
Legal Registered Office Address:	1300 EAST NINTH STREET - CLEVELAND United States of America (USA) 44114