401k Plan data: I2M BENEFIT PLAN plan

I2M BENEFIT PLAN 401k Plan overview

Plan Name	I2M BENEFIT PLAN
Plan identification number	501

I2M BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

CRESTWOOD MEMBRANES INC T/A I2M has sponsored the creation of one or more 401k plans.

Company Name: CRESTWOOD MEMBRANES INC T/A I2M

Employer identification number (EIN): 450700022

NAIC Classification: 423300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan I2M BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-08-01 CHRISTOPHER HACKETT
501 2023-08-01
501 2023-08-01 CHRISTOPHER HACKETT
501 2022-08-01
501 2022-08-01 CHRISTOPHER HACKETT
501 2021-08-01 CHRISTOPHER HACKETT 2023-05-15
501 2020-08-01 CHRISTOPHER HACKETT 2022-05-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2024-08-01	CHRISTOPHER HACKETT
501	2023-08-01
501	2023-08-01	CHRISTOPHER HACKETT
501	2022-08-01
501	2022-08-01	CHRISTOPHER HACKETT
501	2021-08-01	CHRISTOPHER HACKETT	2023-05-15
501	2020-08-01	CHRISTOPHER HACKETT	2022-05-13

Form 5500 Responses for I2M BENEFIT PLAN

2023: I2M BENEFIT PLAN 2023 form 5500 responses
2023-08-01	Type of plan entity	Single employer plan
2023-08-01	Submission has been amended	No
2023-08-01	This submission is the final filing	No
2023-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-08-01	Plan is a collectively bargained plan	No
2023-08-01	Plan funding arrangement – Insurance	Yes
2023-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-08-01	Plan benefit arrangement – Insurance	Yes
2023-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: I2M BENEFIT PLAN 2022 form 5500 responses
2022-08-01	Type of plan entity	Single employer plan
2022-08-01	Submission has been amended	No
2022-08-01	This submission is the final filing	No
2022-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-08-01	Plan is a collectively bargained plan	No
2022-08-01	Plan funding arrangement – Insurance	Yes
2022-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-08-01	Plan benefit arrangement – Insurance	Yes
2022-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: I2M BENEFIT PLAN 2021 form 5500 responses
2021-08-01	Type of plan entity	Single employer plan
2021-08-01	Plan funding arrangement – Insurance	Yes
2021-08-01	Plan benefit arrangement – Insurance	Yes
2020: I2M BENEFIT 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

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504546

Policy instance

Insurance contract or identification number	00504546
Number of Individuals Covered	167
Insurance policy start date	2023-08-01
Insurance policy end date	2024-07-31
Total amount of commissions paid to insurance broker	USD $12,341
Total amount of fees paid to insurance company	USD $2,221
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY
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 $61,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

407784

Policy instance

Insurance contract or identification number	407784
Number of Individuals Covered	165
Insurance policy start date	2023-08-01
Insurance policy end date	2024-07-31
Total amount of commissions paid to insurance broker	USD $64,473
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	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 $429,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

7449

Policy instance

Insurance contract or identification number	7449
Number of Individuals Covered	142
Insurance policy start date	2023-08-01
Insurance policy end date	2024-07-31
Total amount of commissions paid to insurance broker	USD $1,615
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	No
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
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504546

Policy instance

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

407784

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504546

Policy instance

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

407784

Policy instance

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504546

Policy instance

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Company Name:	CRESTWOOD MEMBRANES INC T/A I2M
Employer identification number (EIN):	450700022
NAIC Classification:	423300