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ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 401k Plan overview

Plan NameENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN
Plan identification number 504

ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ENERGY INSPECTION SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name:ENERGY INSPECTION SERVICES, LLC
Employer identification number (EIN):460812391
NAIC Classification:541600

Additional information about ENERGY INSPECTION SERVICES, LLC

Jurisdiction of Incorporation: Colorado Department of State
Incorporation Date: 2012-08-15
Company Identification Number: 20121442941
Legal Registered Office Address: 479 Wolverine Dr

Bayfield
United States of America (USA)
81122

More information about ENERGY INSPECTION SERVICES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042022-01-01KELLIE JAWORSKY2023-05-15
5042021-01-01KELLIE JAWORSKY2022-07-13
5042020-01-01KELLIE JAWORSKY2021-07-16
5042019-12-01KELLIE JAWORSKY2020-08-25
5042018-12-01KELLIE JAWORSKY2020-07-01
5042017-12-01KELLIE JAWORSKY2019-09-13

Plan Statistics for ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN

401k plan membership statisitcs for ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN

Measure Date Value
2022: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01133
Total number of active participants reported on line 7a of the Form 55002022-01-01164
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01164
Number of employers contributing to the scheme2022-01-010
2021: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01240
Total number of active participants reported on line 7a of the Form 55002021-01-01133
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01133
Number of employers contributing to the scheme2021-01-010
2020: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01240
Total number of active participants reported on line 7a of the Form 55002020-01-01240
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01240
Number of employers contributing to the scheme2020-01-010
2019: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01421
Total number of active participants reported on line 7a of the Form 55002019-12-01218
Number of retired or separated participants receiving benefits2019-12-01183
Number of other retired or separated participants entitled to future benefits2019-12-0125
Total of all active and inactive participants2019-12-01426
Number of employers contributing to the scheme2019-12-010
2018: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01150
Total number of active participants reported on line 7a of the Form 55002018-12-01209
Number of retired or separated participants receiving benefits2018-12-01169
Number of other retired or separated participants entitled to future benefits2018-12-0132
Total of all active and inactive participants2018-12-01410
Number of employers contributing to the scheme2018-12-010
2017: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-0181
Total number of active participants reported on line 7a of the Form 55002017-12-01150
Number of retired or separated participants receiving benefits2017-12-010
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-01150
Number of employers contributing to the scheme2017-12-010

Form 5500 Responses for ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN

2022: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan benefit arrangement – InsuranceYes
2018: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan benefit arrangement – InsuranceYes
2017: ENERGY INSPECTION SERVICES LLC LIFE AND DISABILITY BENEFIT PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01First time form 5500 has been submittedYes
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0C2PJ
Policy instance 1
Insurance contract or identification numberGLUG0C2PJ
Number of Individuals Covered164
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,973
Total amount of fees paid to insurance companyUSD $3,164
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $63,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,973
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number495899
Policy instance 1
Insurance contract or identification number495899
Number of Individuals Covered133
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,455
Total amount of fees paid to insurance companyUSD $3,530
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $40,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,614
Amount paid for insurance broker fees3530
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number495899
Policy instance 1
Insurance contract or identification number495899
Number of Individuals Covered100
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,143
Total amount of fees paid to insurance companyUSD $3,637
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $54,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,143
Amount paid for insurance broker fees3637
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number495899
Policy instance 1
Insurance contract or identification number495899
Number of Individuals Covered222
Insurance policy start date2019-12-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $764
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $764
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00495899
Policy instance 1
Insurance contract or identification number00495899
Number of Individuals Covered225
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $7,562
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $66,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,562
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00495899
Policy instance 1
Insurance contract or identification number00495899
Number of Individuals Covered150
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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