401k Plan data: TETRA DEFENSE, LLC HEALTH AND WELFARE PLAN plan

TETRA DEFENSE, LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	TETRA DEFENSE, LLC HEALTH AND WELFARE PLAN
Plan identification number	501

TETRA DEFENSE, LLC HEALTH AND WELFARE 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

401k Sponsoring company profile

TETRA DEFENSE, LLC has sponsored the creation of one or more 401k plans.

Company Name: TETRA DEFENSE, LLC

Employer identification number (EIN): 874173965

NAIC Classification: 541519
NAIC Description: Other Computer Related Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TETRA DEFENSE, LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-02-01
501 2022-02-01 DUSTON WILLIAMS

Form 5500 Responses for TETRA DEFENSE, LLC HEALTH AND WELFARE PLAN

2022: TETRA DEFENSE, LLC HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-02-01	Type of plan entity	Single employer plan
2022-02-01	First time form 5500 has been submitted	Yes
2022-02-01	Submission has been amended	No
2022-02-01	This submission is the final filing	Yes
2022-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-02-01	Plan is a collectively bargained plan	No
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )

Policy contract number

00822 00000

Policy instance

Insurance contract or identification number	00822 00000
Number of Individuals Covered	122
Insurance policy start date	2022-02-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,414
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WYSSTA INSURANCE COMPANY INC. (National Association of Insurance Commissioners NAIC id number: 12352 )

Policy contract number

44280 00000

Policy instance

Insurance contract or identification number	44280 00000
Number of Individuals Covered	120
Insurance policy start date	2022-02-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,785
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

CM10000764

Policy instance

Insurance contract or identification number	CM10000764
Number of Individuals Covered	136
Insurance policy start date	2022-02-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,075
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )

Policy contract number

L05261

Policy instance

Insurance contract or identification number	L05261
Number of Individuals Covered	194
Insurance policy start date	2022-02-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $30,700
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,938,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TETRA DEFENSE, LLC
Employer identification number (EIN):	874173965
NAIC Classification:	541519
NAIC Description:	Other Computer Related Services