401k Plan data: PURE FISHING, INC. MEDICAL PLAN plan

PURE FISHING, INC. MEDICAL PLAN 401k Plan overview

Plan Name	PURE FISHING, INC. MEDICAL PLAN
Plan identification number	501

PURE FISHING, INC. MEDICAL 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 Severance pay Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

PURE FISHING INC. has sponsored the creation of one or more 401k plans.

Company Name: PURE FISHING INC.

Employer identification number (EIN): 420784220

NAIC Classification: 114110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PURE FISHING, INC. MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 TINA L. EAKES 2024-09-13
501 2022-01-01 GARETH L. MOORE 2023-07-26
501 2021-01-01 GARETH L. MOORE 2022-08-23
501 2020-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	TINA L. EAKES	2024-09-13
501	2022-01-01	GARETH L. MOORE	2023-07-26
501	2021-01-01	GARETH L. MOORE	2022-08-23
501	2020-01-01

Plan Statistics for PURE FISHING, INC. MEDICAL PLAN

401k plan membership statisitcs for PURE FISHING, INC. MEDICAL PLAN

Measure Date Value
2023: PURE FISHING, INC. MEDICAL PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 979
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 1,202
Number of retired or separated participants receiving benefits 2023-01-01 10
Number of other retired or separated participants entitled to future benefits 2023-01-01 49
Total of all active and inactive participants 2023-01-01 1,261
Number of employers contributing to the scheme 2023-01-01 0
2022: PURE FISHING, INC. MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,089
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 976
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 55
Total of all active and inactive participants 2022-01-01 1,034
Number of employers contributing to the scheme 2022-01-01 0
2021: PURE FISHING, INC. MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 559
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 710
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 710
Number of employers contributing to the scheme 2021-01-01 0
2020: PURE FISHING, INC. MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 608
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 572
Number of retired or separated participants receiving benefits 2020-01-01 8
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 580

Measure	Date	Value
2023: PURE FISHING, INC. MEDICAL PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	979
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	1,202
Number of retired or separated participants receiving benefits	2023-01-01	10
Number of other retired or separated participants entitled to future benefits	2023-01-01	49
Total of all active and inactive participants	2023-01-01	1,261
Number of employers contributing to the scheme	2023-01-01	0
2022: PURE FISHING, INC. MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,089
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	976
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	55
Total of all active and inactive participants	2022-01-01	1,034
Number of employers contributing to the scheme	2022-01-01	0
2021: PURE FISHING, INC. MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	559
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	710
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	710
Number of employers contributing to the scheme	2021-01-01	0
2020: PURE FISHING, INC. MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	608
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	572
Number of retired or separated participants receiving benefits	2020-01-01	8
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	580

Form 5500 Responses for PURE FISHING, INC. MEDICAL PLAN

2023: PURE FISHING, INC. MEDICAL 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 funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: PURE FISHING, INC. MEDICAL 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: PURE FISHING, INC. MEDICAL PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: PURE FISHING, INC. MEDICAL PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

715051G

Policy instance

Insurance contract or identification number	715051G
Number of Individuals Covered	1202
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $23,875
Total amount of fees paid to insurance company	USD $23,786
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $795,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

70-87824

Policy instance

Insurance contract or identification number	70-87824
Number of Individuals Covered	868
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $220,383
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
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 $88,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

70-87824

Policy instance

Insurance contract or identification number	70-87824
Number of Individuals Covered	979
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $223,430
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $102,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $223,306
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

715051G

Policy instance

Insurance contract or identification number	715051G
Number of Individuals Covered	1310
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $20,166
Total amount of fees paid to insurance company	USD $10,086
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $724,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,166
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

70-87824

Policy instance

Insurance contract or identification number	70-87824
Number of Individuals Covered	710
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $198,115
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105,544
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

917138*

Policy instance

Insurance contract or identification number	917138*
Number of Individuals Covered	1062
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $146,840
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	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 $5,670,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $146,840
Insurance broker organization code?	3

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Company Name:	PURE FISHING INC.
Employer identification number (EIN):	420784220
NAIC Classification:	114110