401k Plan data: MICROPLASTICS, INC. GROUP HEALTH PLAN plan

MICROPLASTICS, INC. GROUP HEALTH PLAN 401k Plan overview

Plan Name	MICROPLASTICS, INC. GROUP HEALTH PLAN
Plan identification number	501

MICROPLASTICS, INC. GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) 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. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name: MICROPLASTICS, INC.

Employer identification number (EIN): 363628136

NAIC Classification: 326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MICROPLASTICS, INC. GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 PATRICIA A. ZEYEN 2023-03-14
501 2021-08-01 PATRICIA A. ZEYEN 2022-04-14
501 2020-08-01 PATRICIA A. ZEYEN 2022-02-07
501 2019-08-01
501 2018-08-01
501 2017-08-01 PATRICIA ZEYEN PATRICIA ZEYEN 2019-02-27
501 2016-08-01 PATTY ZEYEN PATTY ZEYEN 2018-02-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	PATRICIA A. ZEYEN	2023-03-14
501	2021-08-01	PATRICIA A. ZEYEN	2022-04-14
501	2020-08-01	PATRICIA A. ZEYEN	2022-02-07
501	2019-08-01
501	2018-08-01
501	2017-08-01	PATRICIA ZEYEN		PATRICIA ZEYEN	2019-02-27
501	2016-08-01	PATTY ZEYEN		PATTY ZEYEN	2018-02-22

Plan Statistics for MICROPLASTICS, INC. GROUP HEALTH PLAN

401k plan membership statisitcs for MICROPLASTICS, INC. GROUP HEALTH PLAN

Measure Date Value
2022: MICROPLASTICS, INC. GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 145
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 145
Number of employers contributing to the scheme 2022-01-01 0
2021: MICROPLASTICS, INC. GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year 2021-08-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-08-01 84
Number of retired or separated participants receiving benefits 2021-08-01 0
Number of other retired or separated participants entitled to future benefits 2021-08-01 0
Total of all active and inactive participants 2021-08-01 84
Number of employers contributing to the scheme 2021-08-01 0
2020: MICROPLASTICS, INC. GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year 2020-08-01 103
Total number of active participants reported on line 7a of the Form 5500 2020-08-01 100
Number of retired or separated participants receiving benefits 2020-08-01 0
Number of other retired or separated participants entitled to future benefits 2020-08-01 0
Total of all active and inactive participants 2020-08-01 100
Number of employers contributing to the scheme 2020-08-01 0
2019: MICROPLASTICS, INC. GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year 2019-08-01 119
Total number of active participants reported on line 7a of the Form 5500 2019-08-01 103
Number of retired or separated participants receiving benefits 2019-08-01 0
Number of other retired or separated participants entitled to future benefits 2019-08-01 0
Total of all active and inactive participants 2019-08-01 103
2018: MICROPLASTICS, INC. GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-08-01 143
Total number of active participants reported on line 7a of the Form 5500 2018-08-01 119
Number of retired or separated participants receiving benefits 2018-08-01 0
Number of other retired or separated participants entitled to future benefits 2018-08-01 0
Total of all active and inactive participants 2018-08-01 119
2017: MICROPLASTICS, INC. GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-08-01 147
Total number of active participants reported on line 7a of the Form 5500 2017-08-01 143
Number of retired or separated participants receiving benefits 2017-08-01 0
Number of other retired or separated participants entitled to future benefits 2017-08-01 0
Total of all active and inactive participants 2017-08-01 143
2016: MICROPLASTICS, INC. GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-08-01 147
Total number of active participants reported on line 7a of the Form 5500 2016-08-01 147
Number of retired or separated participants receiving benefits 2016-08-01 0
Number of other retired or separated participants entitled to future benefits 2016-08-01 0
Total of all active and inactive participants 2016-08-01 147

Measure	Date	Value
2022: MICROPLASTICS, INC. GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	145
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	145
Number of employers contributing to the scheme	2022-01-01	0
2021: MICROPLASTICS, INC. GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year	2021-08-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-08-01	84
Number of retired or separated participants receiving benefits	2021-08-01	0
Number of other retired or separated participants entitled to future benefits	2021-08-01	0
Total of all active and inactive participants	2021-08-01	84
Number of employers contributing to the scheme	2021-08-01	0
2020: MICROPLASTICS, INC. GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year	2020-08-01	103
Total number of active participants reported on line 7a of the Form 5500	2020-08-01	100
Number of retired or separated participants receiving benefits	2020-08-01	0
Number of other retired or separated participants entitled to future benefits	2020-08-01	0
Total of all active and inactive participants	2020-08-01	100
Number of employers contributing to the scheme	2020-08-01	0
2019: MICROPLASTICS, INC. GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year	2019-08-01	119
Total number of active participants reported on line 7a of the Form 5500	2019-08-01	103
Number of retired or separated participants receiving benefits	2019-08-01	0
Number of other retired or separated participants entitled to future benefits	2019-08-01	0
Total of all active and inactive participants	2019-08-01	103
2018: MICROPLASTICS, INC. GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-08-01	143
Total number of active participants reported on line 7a of the Form 5500	2018-08-01	119
Number of retired or separated participants receiving benefits	2018-08-01	0
Number of other retired or separated participants entitled to future benefits	2018-08-01	0
Total of all active and inactive participants	2018-08-01	119
2017: MICROPLASTICS, INC. GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-08-01	147
Total number of active participants reported on line 7a of the Form 5500	2017-08-01	143
Number of retired or separated participants receiving benefits	2017-08-01	0
Number of other retired or separated participants entitled to future benefits	2017-08-01	0
Total of all active and inactive participants	2017-08-01	143
2016: MICROPLASTICS, INC. GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-08-01	147
Total number of active participants reported on line 7a of the Form 5500	2016-08-01	147
Number of retired or separated participants receiving benefits	2016-08-01	0
Number of other retired or separated participants entitled to future benefits	2016-08-01	0
Total of all active and inactive participants	2016-08-01	147

Form 5500 Responses for MICROPLASTICS, INC. GROUP HEALTH PLAN

2022: MICROPLASTICS, INC. GROUP HEALTH 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: MICROPLASTICS, INC. GROUP HEALTH PLAN 2021 form 5500 responses
2021-08-01	Type of plan entity	Single employer plan
2021-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-08-01	Plan funding arrangement – Insurance	Yes
2021-08-01	Plan benefit arrangement – Insurance	Yes
2020: MICROPLASTICS, INC. GROUP HEALTH PLAN 2020 form 5500 responses
2020-08-01	Type of plan entity	Single employer plan
2020-08-01	Plan funding arrangement – Insurance	Yes
2020-08-01	Plan benefit arrangement – Insurance	Yes
2019: MICROPLASTICS, INC. GROUP HEALTH PLAN 2019 form 5500 responses
2019-08-01	Type of plan entity	Single employer plan
2019-08-01	Submission has been amended	No
2019-08-01	This submission is the final filing	No
2019-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-08-01	Plan is a collectively bargained plan	No
2019-08-01	Plan funding arrangement – Insurance	Yes
2019-08-01	Plan benefit arrangement – Insurance	Yes
2018: MICROPLASTICS, INC. GROUP HEALTH PLAN 2018 form 5500 responses
2018-08-01	Type of plan entity	Single employer plan
2018-08-01	Submission has been amended	No
2018-08-01	This submission is the final filing	No
2018-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-08-01	Plan is a collectively bargained plan	No
2018-08-01	Plan funding arrangement – Insurance	Yes
2018-08-01	Plan benefit arrangement – Insurance	Yes
2017: MICROPLASTICS, INC. GROUP HEALTH PLAN 2017 form 5500 responses
2017-08-01	Type of plan entity	Single employer plan
2017-08-01	Submission has been amended	No
2017-08-01	This submission is the final filing	No
2017-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-08-01	Plan is a collectively bargained plan	No
2017-08-01	Plan funding arrangement – Insurance	Yes
2017-08-01	Plan benefit arrangement – Insurance	Yes
2016: MICROPLASTICS, INC. GROUP HEALTH PLAN 2016 form 5500 responses
2016-08-01	Type of plan entity	Single employer plan
2016-08-01	First time form 5500 has been submitted	Yes
2016-08-01	Submission has been amended	No
2016-08-01	This submission is the final filing	No
2016-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-08-01	Plan is a collectively bargained plan	No
2016-08-01	Plan funding arrangement – Insurance	Yes
2016-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

290674

Policy instance

Insurance contract or identification number	290674
Number of Individuals Covered	145
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $41,601
Total amount of fees paid to insurance company	USD $5,205
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,101,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $41,601
Amount paid for insurance broker fees	5205
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

170026-SHORT

Policy instance

Insurance contract or identification number	170026-SHORT
Number of Individuals Covered	84
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $6,084
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $182,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	6084
Additional information about fees paid to insurance broker	DIRECT COMPENSATION
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B98003, P98003

Policy instance

Insurance contract or identification number	B98003, P98003
Number of Individuals Covered	185
Insurance policy start date	2020-08-01
Insurance policy end date	2021-07-31
Total amount of commissions paid to insurance broker	USD $41,909
Total amount of fees paid to insurance company	USD $3,025
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,059,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $32,513
Amount paid for insurance broker fees	3025
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B98003, P98003

Policy instance

Insurance contract or identification number	B98003, P98003
Number of Individuals Covered	207
Insurance policy start date	2019-08-01
Insurance policy end date	2020-07-31
Total amount of commissions paid to insurance broker	USD $45,875
Total amount of fees paid to insurance company	USD $3,650
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,182,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,875
Amount paid for insurance broker fees	3650
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B98003, P98003

Policy instance

Insurance contract or identification number	B98003, P98003
Number of Individuals Covered	217
Insurance policy start date	2018-08-01
Insurance policy end date	2019-07-31
Total amount of commissions paid to insurance broker	USD $50,199
Total amount of fees paid to insurance company	USD $3,750
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,278,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,199
Amount paid for insurance broker fees	3750
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B98003, P98003

Policy instance

Insurance contract or identification number	B98003, P98003
Number of Individuals Covered	254
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $51,253
Total amount of fees paid to insurance company	USD $3,900
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,314,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MICROPLASTICS, INC.
Employer identification number (EIN):	363628136
NAIC Classification:	326100