401k Plan data: VULCANFORMS HEALTH & WELFARE PLAN plan

VULCANFORMS HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	VULCANFORMS HEALTH & WELFARE PLAN
Plan identification number	501

VULCANFORMS HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: VULCANFORMS INC.

Employer identification number (EIN): 474538402

NAIC Classification: 333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VULCANFORMS HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-02-01 MARTIN FELDMANN 2023-08-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-02-01	MARTIN FELDMANN	2023-08-21

Plan Statistics for VULCANFORMS HEALTH & WELFARE PLAN

401k plan membership statisitcs for VULCANFORMS HEALTH & WELFARE PLAN

Measure Date Value
2022: VULCANFORMS HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-02-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-02-01 382
Number of retired or separated participants receiving benefits 2022-02-01 0
Number of other retired or separated participants entitled to future benefits 2022-02-01 0
Total of all active and inactive participants 2022-02-01 382
Number of employers contributing to the scheme 2022-02-01 0

Measure	Date	Value
2022: VULCANFORMS HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-02-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-02-01	382
Number of retired or separated participants receiving benefits	2022-02-01	0
Number of other retired or separated participants entitled to future benefits	2022-02-01	0
Total of all active and inactive participants	2022-02-01	382
Number of employers contributing to the scheme	2022-02-01	0

Form 5500 Responses for VULCANFORMS HEALTH & WELFARE PLAN

2022: VULCANFORMS HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-02-01	Type of plan entity	Single employer plan
2022-02-01	First time form 5500 has been submitted	Yes
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

10545/10582

Policy instance

Insurance contract or identification number	10545/10582
Number of Individuals Covered	483
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $45,293
Total amount of fees paid to insurance company	USD $16,551
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,368,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,293
Amount paid for insurance broker fees	16551
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

10544

Policy instance

Insurance contract or identification number	10544
Number of Individuals Covered	191
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $9,246
Total amount of fees paid to insurance company	USD $5,987
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,130,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,246
Amount paid for insurance broker fees	5987
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

8074675

Policy instance

Insurance contract or identification number	8074675
Number of Individuals Covered	719
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $14,665
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $14,665
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10263698

Policy instance

Insurance contract or identification number	10263698
Number of Individuals Covered	382
Insurance policy start date	2021-11-01
Insurance policy end date	2022-10-31
Total amount of commissions paid to insurance broker	USD $3,110
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $63,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,110
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	VULCANFORMS INC.
Employer identification number (EIN):	474538402
NAIC Classification:	333200