401k Plan data: LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN plan

LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN
Plan identification number	501

LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

LETTERMENS ENERGY HOLDINGS LLC has sponsored the creation of one or more 401k plans.

Company Name: LETTERMENS ENERGY HOLDINGS LLC

Employer identification number (EIN): 862048643

NAIC Classification: 454310
NAIC Description: Fuel Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 KELLY A. BOSAK 2024-06-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	KELLY A. BOSAK	2024-06-18

Plan Statistics for LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN

Measure Date Value
2023: LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 153
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 153
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	153
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	153
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for LETTERMEN'S ENERGY EMPLOYEE BENEFITS PLAN

2023: LETTERMEN'S ENERGY EMPLOYEE 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 funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

54942-000-00001

Policy instance

Insurance contract or identification number	54942-000-00001
Number of Individuals Covered	88
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
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $53,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 )

Policy contract number

54942-000-00001

Policy instance

Insurance contract or identification number	54942-000-00001
Number of Individuals Covered	85
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,419
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $14,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0C5QZ

Policy instance

Insurance contract or identification number	GLUG0C5QZ
Number of Individuals Covered	153
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $9,858
Total amount of fees paid to insurance company	USD $485
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	Yes
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 $65,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	LETTERMENS ENERGY HOLDINGS LLC
Employer identification number (EIN):	862048643
NAIC Classification:	454310
NAIC Description:	Fuel Dealers