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PACIFIC WEST SITE SVC INC. - INSURANCE PLAN 401k Plan overview

Plan NamePACIFIC WEST SITE SVC INC. - INSURANCE PLAN
Plan identification number 501

PACIFIC WEST SITE SVC INC. - INSURANCE PLAN Benefits

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

401k Sponsoring company profile

PACIFIC WEST SITE SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:PACIFIC WEST SITE SERVICES, INC.
Employer identification number (EIN):911816515
NAIC Classification:561720
NAIC Description:Janitorial Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC WEST SITE SVC INC. - INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012004-01-01CARINA OBRIEN2021-08-09

Plan Statistics for PACIFIC WEST SITE SVC INC. - INSURANCE PLAN

401k plan membership statisitcs for PACIFIC WEST SITE SVC INC. - INSURANCE PLAN

Measure Date Value
2004: PACIFIC WEST SITE SVC INC. - INSURANCE PLAN 2004 401k membership
Total participants, beginning-of-year2004-01-01333
Total number of active participants reported on line 7a of the Form 55002004-01-010
Number of retired or separated participants receiving benefits2004-01-010
Number of other retired or separated participants entitled to future benefits2004-01-010
Total of all active and inactive participants2004-01-010
Number of employers contributing to the scheme2004-01-010

Form 5500 Responses for PACIFIC WEST SITE SVC INC. - INSURANCE PLAN

2004: PACIFIC WEST SITE SVC INC. - INSURANCE PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01Submission has been amendedYes
2004-01-01This submission is the final filingYes
2004-01-01Plan funding arrangement – InsuranceYes
2004-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number9185
Policy instance 1
Insurance contract or identification number9185
Number of Individuals Covered269
Insurance policy start date2003-04-01
Insurance policy end date2004-03-31
Total amount of commissions paid to insurance brokerUSD $8,286
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $421,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,286
Amount paid for insurance broker fees0
Insurance broker organization code?3

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