401k Plan data: MIDDLEVILLE ENGINEERED SOLUTIONS HEALTH AND WELFARE PLAN plan

MIDDLEVILLE ENGINEERED SOLUTIONS HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	MIDDLEVILLE ENGINEERED SOLUTIONS HEALTH AND WELFARE PLAN
Plan identification number	501

MIDDLEVILLE ENGINEERED SOLUTIONS 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 Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MIDDLEVILLE ENGINEERED SOLUTIONS, LLC has sponsored the creation of one or more 401k plans.

Company Name: MIDDLEVILLE ENGINEERED SOLUTIONS, LLC

Employer identification number (EIN): 922394920

NAIC Classification: 332110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDDLEVILLE ENGINEERED SOLUTIONS HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 HANNAH HAWLEY 2024-05-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	HANNAH HAWLEY	2024-05-20

Form 5500 Responses for MIDDLEVILLE ENGINEERED SOLUTIONS HEALTH AND WELFARE PLAN

2023: MIDDLEVILLE ENGINEERED SOLUTIONS HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
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

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

228093

Policy instance

Insurance contract or identification number	228093
Number of Individuals Covered	181
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $664
Total amount of fees paid to insurance company	USD $405
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

1139994

Policy instance

Insurance contract or identification number	1139994
Number of Individuals Covered	246
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,864
Total amount of fees paid to insurance company	USD $2,217
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $116,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MIDDLEVILLE ENGINEERED SOLUTIONS, LLC
Employer identification number (EIN):	922394920
NAIC Classification:	332110