401k Plan data: WESTERN REFINERY SERVICES WELFARE BENEFIT PLAN plan

WESTERN REFINERY SERVICES WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	WESTERN REFINERY SERVICES WELFARE BENEFIT PLAN
Plan identification number	501

WESTERN REFINERY SERVICES WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	SELECT distinct(Description) AS Description FROM 401k_benefit_codes LEFT JOIN 401k_benefit_code_description ON BenefitCode=Code COLLATE utf8_unicode_ci WHERE EIN='911473401' AND PlanID='501'

401k Sponsoring company profile

WESTERN REFINERY SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: WESTERN REFINERY SERVICES, INC.

Employer identification number (EIN): 911473401

NAIC Classification: 238900

Additional information about WESTERN REFINERY SERVICES, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1990-02-07

Company Identification Number: 601229532

Legal Registered Office Address: 400 N COMMERCIAL ST

BELLINGHAM
United States of America (USA)
982250000

More information about WESTERN REFINERY SERVICES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WESTERN REFINERY SERVICES WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 KAREN DYKSTRA 2024-07-03
501 2022-01-01 TIM DENBLEYKER 2023-04-19
501 2021-01-01 TIM DENBLEYKER 2022-08-08
501 2020-01-01 TIM DENBLEYKER 2021-06-23
501 2019-01-01 TIM DENBLEYKER 2020-06-26
501 2018-01-01
501 2017-01-01
501 2016-01-01 TIMOTHY DENBLEYKER
501 2015-01-01 TIMOTHY DENBLEYKER
501 2014-01-01 GREG FRANSEN
501 2013-01-01 JERRY LIBOLT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	KAREN DYKSTRA	2024-07-03
501	2022-01-01	TIM DENBLEYKER	2023-04-19
501	2021-01-01	TIM DENBLEYKER	2022-08-08
501	2020-01-01	TIM DENBLEYKER	2021-06-23
501	2019-01-01	TIM DENBLEYKER	2020-06-26
501	2018-01-01
501	2017-01-01
501	2016-01-01	TIMOTHY DENBLEYKER
501	2015-01-01	TIMOTHY DENBLEYKER
501	2014-01-01	GREG FRANSEN
501	2013-01-01	JERRY LIBOLT

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BMJ4

Policy instance

Insurance contract or identification number	GLUG0BMJ4
Number of Individuals Covered	219
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $17,633
Total amount of fees paid to insurance company	USD $9,847
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	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $117,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

926592

Policy instance

Insurance contract or identification number	926592
Number of Individuals Covered	255
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $58,578
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,636,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30102589

Policy instance

Insurance contract or identification number	30102589
Number of Individuals Covered	104
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,061
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BMJ4

Policy instance

Insurance contract or identification number	GLUG0BMJ4
Number of Individuals Covered	230
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $17,321
Total amount of fees paid to insurance company	USD $7,696
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	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $115,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

926592

Policy instance

Insurance contract or identification number	926592
Number of Individuals Covered	272
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $56,602
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,374,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30102589

Policy instance

Insurance contract or identification number	30102589
Number of Individuals Covered	101
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $952
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4016394

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30102589

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BMJ4

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BMJ4

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4016394

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10119683

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4016394

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

14802000

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10119683

Policy instance

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6440500

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10119683

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

148020

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

1480000

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10119683

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10119683

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10092604

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10119683

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

471152

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

1480000

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10119683

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

471152

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4000026 ET AL

Policy instance

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Company Name:	WESTERN REFINERY SERVICES, INC.
Employer identification number (EIN):	911473401
NAIC Classification:	238900

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1990-02-07
Company Identification Number:	601229532
Legal Registered Office Address:	400 N COMMERCIAL ST BELLINGHAM United States of America (USA) 982250000