401k Plan data: FIRST WESTERN BANK CAFETERIA PLAN plan

FIRST WESTERN BANK CAFETERIA PLAN 401k Plan overview

Plan Name	FIRST WESTERN BANK CAFETERIA PLAN
Plan identification number	501

FIRST WESTERN BANK CAFETERIA PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

FIRST WESTERN BANK has sponsored the creation of one or more 401k plans.

Company Name: FIRST WESTERN BANK

Employer identification number (EIN): 710031220

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST WESTERN BANK CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 DEBBIE DANEKAS 2024-08-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	DEBBIE DANEKAS	2024-08-26

Plan Statistics for FIRST WESTERN BANK CAFETERIA PLAN

401k plan membership statisitcs for FIRST WESTERN BANK CAFETERIA PLAN

Measure Date Value
2023: FIRST WESTERN BANK CAFETERIA PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 221
Total of all active and inactive participants 2023-01-01 221

Measure	Date	Value
2023: FIRST WESTERN BANK CAFETERIA PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	221
Total of all active and inactive participants	2023-01-01	221

Form 5500 Responses for FIRST WESTERN BANK CAFETERIA PLAN

2023: FIRST WESTERN BANK CAFETERIA PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

026003

Policy instance

Insurance contract or identification number	026003
Number of Individuals Covered	94
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

029652

Policy instance

Insurance contract or identification number	029652
Number of Individuals Covered	94
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061954

Policy instance

Insurance contract or identification number	061954
Number of Individuals Covered	90
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E3681897

Policy instance

Insurance contract or identification number	E3681897
Number of Individuals Covered	67
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $18,003
Total amount of fees paid to insurance company	USD $2,869
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $71,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50046670

Policy instance

Insurance contract or identification number	50046670
Number of Individuals Covered	116
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $3,379
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $30,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50046670

Policy instance

Insurance contract or identification number	50046670
Number of Individuals Covered	102
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,466
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50046670

Policy instance

Insurance contract or identification number	50046670
Number of Individuals Covered	115
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $5,759
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FIRST WESTERN BANK
Employer identification number (EIN):	710031220
NAIC Classification:	522110
NAIC Description:	Commercial Banking