401k Plan data: NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN plan

NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

NORFLEET LAND SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name: NORFLEET LAND SERVICES, LLC

Employer identification number (EIN): 811723327

NAIC Classification: 213110
NAIC Description: Support Activities for Mining

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-06-01 CASEY FIELDS 2024-03-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-06-01	CASEY FIELDS	2024-03-01

Plan Statistics for NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 113
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 183
Number of retired or separated participants receiving benefits 2022-06-01 4
Number of other retired or separated participants entitled to future benefits 2022-06-01 4
Total of all active and inactive participants 2022-06-01 191

Measure	Date	Value
2022: NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	113
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	183
Number of retired or separated participants receiving benefits	2022-06-01	4
Number of other retired or separated participants entitled to future benefits	2022-06-01	4
Total of all active and inactive participants	2022-06-01	191

Form 5500 Responses for NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN

2022: NORFLEET LAND SERVICES HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	First time form 5500 has been submitted	Yes
2022-06-01	Submission has been amended	No
2022-06-01	This submission is the final filing	No
2022-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-06-01	Plan is a collectively bargained plan	No
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

320910

Policy instance

Insurance contract or identification number	320910
Number of Individuals Covered	298
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $18,912
Total amount of fees paid to insurance company	USD $60,180
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 $1,032,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	60180
Additional information about fees paid to insurance broker	FEES

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1111732

Policy instance

Insurance contract or identification number	1111732
Number of Individuals Covered	369
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $45,566
Total amount of fees paid to insurance company	USD $11,281
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	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ADD, ACCIDENT, CRITICAL ILLNESS, EAP, VOL LIFE, VOL ADD
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 $217,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,163
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

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Company Name:	NORFLEET LAND SERVICES, LLC
Employer identification number (EIN):	811723327
NAIC Classification:	213110
NAIC Description:	Support Activities for Mining