401k Plan data: EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN plan

EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number	501

EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT 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 Other welfare benefit cover

401k Sponsoring company profile

EAGLERIDGE OPERATING, LLC has sponsored the creation of one or more 401k plans.

Company Name: EAGLERIDGE OPERATING, LLC

Employer identification number (EIN): 510626347

NAIC Classification: 211130
NAIC Description: Natural Gas Extraction

Additional information about EAGLERIDGE OPERATING, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2009-02-11

Company Identification Number: 0801085417

Legal Registered Office Address: PO BOX 191447

DALLAS
United States of America (USA)
75219

More information about EAGLERIDGE OPERATING, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-12-01

Plan Statistics for EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2022: EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-12-01 115
Total number of active participants reported on line 7a of the Form 5500 2022-12-01 118
Number of retired or separated participants receiving benefits 2022-12-01 0
Number of other retired or separated participants entitled to future benefits 2022-12-01 0
Total of all active and inactive participants 2022-12-01 118

Measure	Date	Value
2022: EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-12-01	115
Total number of active participants reported on line 7a of the Form 5500	2022-12-01	118
Number of retired or separated participants receiving benefits	2022-12-01	0
Number of other retired or separated participants entitled to future benefits	2022-12-01	0
Total of all active and inactive participants	2022-12-01	118

Form 5500 Responses for EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN

2022: EAGLERIDGE ENERGY, LLC EMPLOYEE WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-12-01	Type of plan entity	Single employer plan
2022-12-01	First time form 5500 has been submitted	Yes
2022-12-01	Submission has been amended	No
2022-12-01	This submission is the final filing	No
2022-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-12-01	Plan is a collectively bargained plan	No
2022-12-01	Plan funding arrangement – Insurance	Yes
2022-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

102210

Policy instance

Insurance contract or identification number	102210
Number of Individuals Covered	324
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $90,914
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $2,064,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $90,914
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VF027668

Policy instance

Insurance contract or identification number	VF027668
Number of Individuals Covered	105
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $2,239
Total amount of fees paid to insurance company	USD $1,545
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $22,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,239
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00614280-0001

Policy instance

Insurance contract or identification number	G 00614280-0001
Number of Individuals Covered	122
Insurance policy start date	2023-01-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $12,847
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D, VOL. TERM AD&D, DEPENDENT VOL. TERM AD&D, VOL. TERM LIFE, DEPENDENT VOL. TERM LIFE
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $85,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,847
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

Potentially related plans

EAGLERIDGE ENERGY, LLC 401K PLAN [EIN = 264273513]

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Company Name:	EAGLERIDGE OPERATING, LLC
Employer identification number (EIN):	510626347
NAIC Classification:	211130
NAIC Description:	Natural Gas Extraction

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2009-02-11
Company Identification Number:	0801085417
Legal Registered Office Address:	PO BOX 191447 DALLAS United States of America (USA) 75219