401k Plan data: ELK OPERATING SERVICES, LLC HEALTH AND WELFARE BENEFITS PLAN plan

ELK OPERATING SERVICES, LLC HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	ELK OPERATING SERVICES, LLC HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

ELK OPERATING SERVICES, LLC HEALTH AND WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

ELK OPERATING SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name: ELK OPERATING SERVICES, LLC

Employer identification number (EIN): 823513197

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ELK OPERATING SERVICES, LLC HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 ROBIN TREADWELL 2024-09-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	ROBIN TREADWELL	2024-09-19

Form 5500 Responses for ELK OPERATING SERVICES, LLC HEALTH AND WELFARE BENEFITS PLAN

2023: ELK OPERATING SERVICES, LLC HEALTH AND WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

621116

Policy instance

Insurance contract or identification number	621116
Number of Individuals Covered	195
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $45,272
Total amount of fees paid to insurance company	USD $134
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $982,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30079442

Policy instance

Insurance contract or identification number	30079442
Number of Individuals Covered	113
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10237294

Policy instance

Insurance contract or identification number	10237294
Number of Individuals Covered	115
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $14,247
Total amount of fees paid to insurance company	USD $8,911
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $178,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ELK OPERATING SERVICES, LLC
Employer identification number (EIN):	823513197
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services