401k Plan data: OILFIELD INSTRUMENTATION USA, INC. plan

OILFIELD INSTRUMENTATION USA, INC. 401k Plan overview

Plan Name	OILFIELD INSTRUMENTATION USA, INC.
Plan identification number	501

OILFIELD INSTRUMENTATION USA, INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

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

Company Name: ALDONSA, INC.

Employer identification number (EIN): 721126980

NAIC Classification: 213110
NAIC Description: Support Activities for Mining

Additional information about ALDONSA, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2006-07-13

Company Identification Number: 0800680896

Legal Registered Office Address: 120 WELLHEAD DR

BROUSSARD
United States of America (USA)
70518

More information about ALDONSA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OILFIELD INSTRUMENTATION USA, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 HYDI STUART HYDI STUART 2016-06-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	HYDI STUART		HYDI STUART	2016-06-07

Plan Statistics for OILFIELD INSTRUMENTATION USA, INC.

401k plan membership statisitcs for OILFIELD INSTRUMENTATION USA, INC.

Measure Date Value
2015: OILFIELD INSTRUMENTATION USA, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 85
Total of all active and inactive participants 2015-01-01 85
Total participants 2015-01-01 85

Measure	Date	Value
2015: OILFIELD INSTRUMENTATION USA, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	85
Total of all active and inactive participants	2015-01-01	85
Total participants	2015-01-01	85

Form 5500 Responses for OILFIELD INSTRUMENTATION USA, INC.

2015: OILFIELD INSTRUMENTATION USA, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

79364FF2

Policy instance

Insurance contract or identification number	79364FF2
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $35,648
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 $666,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $3,493
Insurance broker organization code?	3
Amount paid for insurance broker fees	15796
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION PER INFORMATION PROVIDED BY BLUE CROSS.
Insurance broker name	GLOBAL FINANCIAL RESOURCES INC.

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Company Name:	ALDONSA, INC.
Employer identification number (EIN):	721126980
NAIC Classification:	213110
NAIC Description:	Support Activities for Mining

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2006-07-13
Company Identification Number:	0800680896
Legal Registered Office Address:	120 WELLHEAD DR BROUSSARD United States of America (USA) 70518