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WESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan NameWESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN
Plan identification number 501

WESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Other welfare benefit cover

401k Sponsoring company profile

WESTERN STATES MECHANICAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:WESTERN STATES MECHANICAL, INC.
Employer identification number (EIN):870475065
NAIC Classification:238220
NAIC Description:Plumbing, Heating, and Air-Conditioning Contractors

Additional information about WESTERN STATES MECHANICAL, INC.

Jurisdiction of Incorporation: Colorado Department of State
Incorporation Date: 1993-04-15
Company Identification Number: 19931040129
Legal Registered Office Address: 5235 W Mississippi Ave

Lakewood
United States of America (USA)
80226

More information about WESTERN STATES MECHANICAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01ELIZABETH TERRY2024-08-29 ELIZABETH TERRY2024-08-29

Plan Statistics for WESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN

401k plan membership statisitcs for WESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN

Measure Date Value
2023: WESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01100
Total number of active participants reported on line 7a of the Form 55002023-01-01103
Total of all active and inactive participants2023-01-01103
Total participants2023-01-01103

Form 5500 Responses for WESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN

2023: WESTERN STATES MECHANICAL HEALTH & WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01First time form 5500 has been submittedYes
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number431843
Policy instance 1
Insurance contract or identification number431843
Number of Individuals Covered39
Insurance policy start date2023-01-01
Insurance policy end date2024-01-01
Total amount of commissions paid to insurance brokerUSD $1,269
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedATTAINED AGE CRITICAL ILLNESS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number431844
Policy instance 2
Insurance contract or identification number431844
Number of Individuals Covered32
Insurance policy start date2023-01-01
Insurance policy end date2024-01-01
Total amount of commissions paid to insurance brokerUSD $1,351
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedHOSPITAL EE PAID
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number431842
Policy instance 3
Insurance contract or identification number431842
Number of Individuals Covered59
Insurance policy start date2023-01-01
Insurance policy end date2024-01-01
Total amount of commissions paid to insurance brokerUSD $1,829
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedGRP ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number008508
Policy instance 4
Insurance contract or identification number008508
Number of Individuals Covered103
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $7,890
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $110,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HSA HEALTH INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 15743 )
Policy contract numberWESTSM1SN
Policy instance 5
Insurance contract or identification numberWESTSM1SN
Number of Individuals Covered325
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $40,037
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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