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AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameAXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN
Plan identification number 501

AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

AXIS ENERGY ADMINISTRATION, LLC has sponsored the creation of one or more 401k plans.

Company Name:AXIS ENERGY ADMINISTRATION, LLC
Employer identification number (EIN):831004542
NAIC Classification:213110
NAIC Description: Support Activities for Mining

Additional information about AXIS ENERGY ADMINISTRATION, LLC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2019-05-08
Company Identification Number: 0803313025
Legal Registered Office Address: 140 E TYLER ST STE 520

LONGVIEW
United States of America (USA)
75601

More information about AXIS ENERGY ADMINISTRATION, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01TRACY SMITH2023-08-29
5012021-01-01SHELLYE BURLISON2022-07-20
5012020-01-01SHELLYE BURLISON2021-07-15
5012020-01-01SHELLYE BURLISON2022-07-25
5012019-01-01SHELLYE BURLISON2020-07-21

Plan Statistics for AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN

Measure Date Value
2022: AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-010
Total number of active participants reported on line 7a of the Form 55002022-01-010
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 participants2022-01-010
Number of employers contributing to the scheme2022-01-010
2021: AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01209
Total number of active participants reported on line 7a of the Form 55002021-01-01209
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 participants2021-01-01209
Number of employers contributing to the scheme2021-01-010
2020: AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01245
Total number of active participants reported on line 7a of the Form 55002020-01-01209
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 participants2020-01-01209
Number of employers contributing to the scheme2020-01-010
2019: AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01463
Total number of active participants reported on line 7a of the Form 55002019-01-01241
Number of retired or separated participants receiving benefits2019-01-014
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01245
Number of employers contributing to the scheme2019-01-010

Form 5500 Responses for AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN

2022: AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: AXIS ENERGY ADMINISTRATION, LLC HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01First time form 5500 has been submittedYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF025998
Policy instance 1
Insurance contract or identification numberF025998
Number of Individuals Covered943
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $58,029
Total amount of fees paid to insurance companyUSD $8,036
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $544,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,029
Amount paid for insurance broker fees8036
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number275333
Policy instance 2
Insurance contract or identification number275333
Number of Individuals Covered1917
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $26,485
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $436,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees26485
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number932863
Policy instance 1
Insurance contract or identification number932863
Number of Individuals Covered492
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $14,792
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $235,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees14792
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number932863
Policy instance 1
Insurance contract or identification number932863
Number of Individuals Covered492
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $241
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $235,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees241
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5955424
Policy instance 1
Insurance contract or identification number5955424
Number of Individuals Covered241
Insurance policy start date2019-01-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $73
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $217,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees73
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number932863
Policy instance 2
Insurance contract or identification number932863
Number of Individuals Covered241
Insurance policy start date2019-07-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $457,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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