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

PURE FISHING, INC. DENTAL PLAN 401k Plan overview

Plan Name	PURE FISHING, INC. DENTAL PLAN
Plan identification number	502

PURE FISHING, INC. DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

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. DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-01-01 GARETH L. MOORE 2022-08-23
502 2020-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-01-01	GARETH L. MOORE	2022-08-23
502	2020-01-01

Plan Statistics for PURE FISHING, INC. DENTAL PLAN

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

Measure Date Value
2021: PURE FISHING, INC. DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 606
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
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 0
Number of employers contributing to the scheme 2021-01-01 0
2020: PURE FISHING, INC. DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 574
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 565
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 2020-01-01 573

Measure	Date	Value
2021: PURE FISHING, INC. DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	606
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
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	0
Number of employers contributing to the scheme	2021-01-01	0
2020: PURE FISHING, INC. DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	574
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	565
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	573

Form 5500 Responses for PURE FISHING, INC. DENTAL PLAN

2021: PURE FISHING, INC. DENTAL PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: PURE FISHING, INC. DENTAL 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

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	723
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,949
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
Commission paid to Insurance Broker	USD $6,897
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	No
Dental Insurance Welfare Benefit	Yes
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