401k Plan data: BCBS OF ALABAMA HEALTH plan

BCBS OF ALABAMA HEALTH 401k Plan overview

Plan Name	BCBS OF ALABAMA HEALTH
Plan identification number	501

BCBS OF ALABAMA HEALTH 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)
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.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

SOUTHERN EARTH SCIENCES, INC. has sponsored the creation of one or more 401k plans.

Company Name: SOUTHERN EARTH SCIENCES, INC.

Employer identification number (EIN): 630710398

NAIC Classification: 541330
NAIC Description: Engineering Services

Additional information about SOUTHERN EARTH SCIENCES, INC.

Jurisdiction of Incorporation: Alabama Secretary of State

Incorporation Date: 1976-06-29

Company Identification Number: 042-119

Legal Registered Office Address: 6352 PICCADILLY SQUARE DR MOBILE, AL 36609-5143

United States of America (USA)

More information about SOUTHERN EARTH SCIENCES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BCBS OF ALABAMA HEALTH

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-07-01 CINDY GIDDENS 2021-04-13
501 2014-06-01 CINDY GIDDENS
501 2013-06-01 CINDY GIDDENS
501 2012-06-01 CINDY GIDDENS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2019-07-01	CINDY GIDDENS	2021-04-13
501	2014-06-01	CINDY GIDDENS
501	2013-06-01	CINDY GIDDENS
501	2012-06-01	CINDY GIDDENS

Plan Statistics for BCBS OF ALABAMA HEALTH

401k plan membership statisitcs for BCBS OF ALABAMA HEALTH

Measure Date Value
2019: BCBS OF ALABAMA HEALTH 2019 401k membership
Total participants, beginning-of-year 2019-07-01 108
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 96
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 96
Number of employers contributing to the scheme 2019-07-01 0
2014: BCBS OF ALABAMA HEALTH 2014 401k membership
Total participants, beginning-of-year 2014-06-01 100
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 96
Number of retired or separated participants receiving benefits 2014-06-01 3
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 99
2013: BCBS OF ALABAMA HEALTH 2013 401k membership
Total participants, beginning-of-year 2013-06-01 106
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 100
Number of retired or separated participants receiving benefits 2013-06-01 1
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 101
2012: BCBS OF ALABAMA HEALTH 2012 401k membership
Total participants, beginning-of-year 2012-06-01 139
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 139
Number of retired or separated participants receiving benefits 2012-06-01 0
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 139

Measure	Date	Value
2019: BCBS OF ALABAMA HEALTH 2019 401k membership
Total participants, beginning-of-year	2019-07-01	108
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	96
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	96
Number of employers contributing to the scheme	2019-07-01	0
2014: BCBS OF ALABAMA HEALTH 2014 401k membership
Total participants, beginning-of-year	2014-06-01	100
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	96
Number of retired or separated participants receiving benefits	2014-06-01	3
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	99
2013: BCBS OF ALABAMA HEALTH 2013 401k membership
Total participants, beginning-of-year	2013-06-01	106
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	100
Number of retired or separated participants receiving benefits	2013-06-01	1
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	101
2012: BCBS OF ALABAMA HEALTH 2012 401k membership
Total participants, beginning-of-year	2012-06-01	139
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	139
Number of retired or separated participants receiving benefits	2012-06-01	0
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	139

Form 5500 Responses for BCBS OF ALABAMA HEALTH

2019: BCBS OF ALABAMA HEALTH 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: BCBS OF ALABAMA HEALTH 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	No
2014-06-01	This submission is the final filing	No
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: BCBS OF ALABAMA HEALTH 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Submission has been amended	No
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: BCBS OF ALABAMA HEALTH 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Submission has been amended	No
2012-06-01	This submission is the final filing	No
2012-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-06-01	Plan is a collectively bargained plan	No
2012-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

469632

Policy instance

Insurance contract or identification number	469632
Number of Individuals Covered	98
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $22,637
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $190,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,503
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	SOUTHERN EARTH SCIENCES, INC.
Employer identification number (EIN):	630710398
NAIC Classification:	541330
NAIC Description:	Engineering Services

Jurisdiction of Incorporation:	Alabama Secretary of State
Incorporation Date:	1976-06-29
Company Identification Number:	042-119
Legal Registered Office Address:	6352 PICCADILLY SQUARE DR MOBILE, AL 36609-5143 United States of America (USA)