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ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN 401k Plan overview

Plan NameENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN
Plan identification number 501

ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

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 MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01KELLIE JAWORSKY2023-05-15
5012021-01-01KELLIE JAWORSKY2022-07-13
5012020-01-01KELLIE JAWORSKY2021-07-16
5012019-12-01KELLIE JAWORSKY2020-08-25
5012018-12-01KELLIE JAWORSKY2020-07-01
5012017-12-01KELLIE JAWORSKY2019-09-13

Plan Statistics for ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN

401k plan membership statisitcs for ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN

Measure Date Value
2022: ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01110
Total number of active participants reported on line 7a of the Form 55002022-01-01187
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 participants2022-01-01187
Number of employers contributing to the scheme2022-01-010
2021: ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01258
Total number of active participants reported on line 7a of the Form 55002021-01-01110
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 participants2021-01-01110
Number of employers contributing to the scheme2021-01-010
2020: ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01179
Total number of active participants reported on line 7a of the Form 55002020-01-01100
Number of retired or separated participants receiving benefits2020-01-0125
Number of other retired or separated participants entitled to future benefits2020-01-01133
Total of all active and inactive participants2020-01-01258
Number of employers contributing to the scheme2020-01-010
2019: ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01240
Total number of active participants reported on line 7a of the Form 55002019-12-01160
Number of retired or separated participants receiving benefits2019-12-0177
Number of other retired or separated participants entitled to future benefits2019-12-0125
Total of all active and inactive participants2019-12-01262
Number of employers contributing to the scheme2019-12-010
2018: ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01138
Total number of active participants reported on line 7a of the Form 55002018-12-01147
Number of retired or separated participants receiving benefits2018-12-0174
Number of other retired or separated participants entitled to future benefits2018-12-0132
Total of all active and inactive participants2018-12-01253
Number of employers contributing to the scheme2018-12-010
2017: ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01109
Total number of active participants reported on line 7a of the Form 55002017-12-01129
Number of retired or separated participants receiving benefits2017-12-019
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-01138
Number of employers contributing to the scheme2017-12-010

Form 5500 Responses for ENERGY INSPECTION SERVICES LLC MEDICAL BENEFIT PLAN

2022: ENERGY INSPECTION SERVICES LLC MEDICAL 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 MEDICAL 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 MEDICAL 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 MEDICAL 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 MEDICAL 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 MEDICAL 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

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number630986
Policy instance 1
Insurance contract or identification number630986
Number of Individuals Covered187
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 $65,443
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,701,551
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 fees65443
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00630986
Policy instance 1
Insurance contract or identification number00630986
Number of Individuals Covered166
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 $58,947
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,418,579
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 fees25024
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number916108
Policy instance 1
Insurance contract or identification number916108
Number of Individuals Covered29
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $68,141
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,701,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,141
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number916108
Policy instance 1
Insurance contract or identification number916108
Number of Individuals Covered378
Insurance policy start date2019-12-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,272
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $165,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,272
Amount paid for insurance broker fees0
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0767696
Policy instance 2
Insurance contract or identification number0767696
Number of Individuals Covered247
Insurance policy start date2018-12-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,741
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,741
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number916108
Policy instance 1
Insurance contract or identification number916108
Number of Individuals Covered379
Insurance policy start date2019-01-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $83,557
Total amount of fees paid to insurance companyUSD $6,035
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,671,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $83,557
Amount paid for insurance broker fees6035
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number767696
Policy instance 1
Insurance contract or identification number767696
Number of Individuals Covered129
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
Health Insurance Welfare BenefitYes
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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