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SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 502

SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT 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

SOUTHWEST ENERGY SOLUTIONS INC has sponsored the creation of one or more 401k plans.

Company Name:SOUTHWEST ENERGY SOLUTIONS INC
Employer identification number (EIN):860849180
NAIC Classification:221100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022020-01-01KRIS PAGE-IVERSON2021-07-16
5022019-01-01KRISTEN PAGE-IVERSON2020-08-28

Plan Statistics for SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2020: SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01183
Total number of active participants reported on line 7a of the Form 55002020-01-010
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 participants2020-01-010
Number of employers contributing to the scheme2020-01-010
2019: SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01190
Total number of active participants reported on line 7a of the Form 55002019-01-01183
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01183
Number of employers contributing to the scheme2019-01-010

Form 5500 Responses for SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN

2020: SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01This submission is the final filingYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: SOUTHWEST ENERGY SOLUTIONS EMPLOYEE HEALTH AND WELFARE BENEFIT 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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number36464
Policy instance 1
Insurance contract or identification number36464
Number of Individuals Covered134
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $41,585
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,800
Amount paid for insurance broker fees0
Insurance broker organization code?3
COUNSELING & FAMILY RESOURCES, LTD, DBA EAP PREFERRED (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number15135102
Policy instance 2
Insurance contract or identification number15135102
Number of Individuals Covered183
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 $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $3,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1104553
Policy instance 3
Insurance contract or identification number1104553
Number of Individuals Covered368
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,847
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
Welfare Benefit Premiums Paid to CarrierUSD $114,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,847
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number36464
Policy instance 1
Insurance contract or identification number36464
Number of Individuals Covered134
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $37,487
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,487
Amount paid for insurance broker fees0
Insurance broker organization code?3
COUNSELING & FAMILY RESOURCES, LTD, DBA EAP PREFERRED (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number15135102
Policy instance 2
Insurance contract or identification number15135102
Number of Individuals Covered198
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $4,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1104553
Policy instance 3
Insurance contract or identification number1104553
Number of Individuals Covered380
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $7,323
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
Welfare Benefit Premiums Paid to CarrierUSD $120,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,083
Amount paid for insurance broker fees0
Insurance broker organization code?3

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