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| Plan Name | SIW SOLUTIONS LLC EMPLOYEE WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SIW SOLUTIONS LLC |
| Employer identification number (EIN): | 233319022 |
| NAIC Classification: | 423300 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-03-01 | ||||
| 501 | 2021-03-01 | KATIE MARVIN |
| 2021: SIW SOLUTIONS LLC EMPLOYEE WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | First time form 5500 has been submitted | Yes |
| 2021-03-01 | Submission has been amended | No |
| 2021-03-01 | This submission is the final filing | Yes |
| 2021-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2021-03-01 | Plan is a collectively bargained plan | No |
| 2021-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | S8178 |
| Policy instance | 1 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |
| Policy contract number | 50044419 |
| Policy instance | 2 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E5465109 |
| Policy instance | 3 |
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