401k Plan data: KT FABRICATION, INC. WELFARE BENEFIT PLAN plan

KT FABRICATION, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	KT FABRICATION, INC. WELFARE BENEFIT PLAN
Plan identification number	501

KT FABRICATION, INC. 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name: KT FABRICATION, INC.

Employer identification number (EIN): 860697267

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KT FABRICATION, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-10-01
501 2021-10-01
501 2021-10-01 ANGELA NORPEL
501 2020-10-01
501 2017-10-01
501 2017-10-01 DAVID TIDWELL
501 2016-10-01 ANGELA NORPEL ANGELA NORPEL 2018-05-25
501 2015-10-01 ANGELA NORPEL

Plan Statistics for KT FABRICATION, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for KT FABRICATION, INC. WELFARE BENEFIT PLAN

Measure Date Value
2021: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 219
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 161
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 161
2020: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 285
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 219
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 219
2017: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2017 401k membership
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
2016: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 78
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 173
Number of retired or separated participants receiving benefits 2016-10-01 2
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 175
2015: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 0
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 78
Total of all active and inactive participants 2015-10-01 78

Measure	Date	Value
2021: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	219
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	161
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	161
2020: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	285
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	219
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	219
2017: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2017 401k membership
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
2016: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	78
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	173
Number of retired or separated participants receiving benefits	2016-10-01	2
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	175
2015: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	0
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	78
Total of all active and inactive participants	2015-10-01	78

Form 5500 Responses for KT FABRICATION, INC. WELFARE BENEFIT PLAN

2021: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2020: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2016: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: KT FABRICATION, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	First time form 5500 has been submitted	Yes
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	922199
Policy instance	1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	922199
Policy instance	1
DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )
Policy contract number	555755 36574
Policy instance	1
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number	30917
Policy instance	2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	R0382887
Policy instance	3
DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )
Policy contract number	20590 00000
Policy instance	4

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Company Name:	KT FABRICATION, INC.
Employer identification number (EIN):	860697267
NAIC Classification:	236200