401k Plan data: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC plan

EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 401k Plan overview

Plan Name	EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC
Plan identification number	501

EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

CA CAPITAL OPERATIONS LLC has sponsored the creation of one or more 401k plans.

Company Name: CA CAPITAL OPERATIONS LLC

Employer identification number (EIN): 271460592

NAIC Classification: 531390
NAIC Description: Other Activities Related to Real Estate

Additional information about CA CAPITAL OPERATIONS LLC

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: 201001510340

More information about CA CAPITAL OPERATIONS LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01 PAT GAUDIN 2023-07-26
501 2021-07-01 PAT GAUDIN 2023-03-01
501 2020-07-01
501 2019-07-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-07-01	PAT GAUDIN	2023-07-26
501	2021-07-01	PAT GAUDIN	2023-03-01
501	2020-07-01
501	2019-07-01

Plan Statistics for EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC

401k plan membership statisitcs for EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC

Measure Date Value
2022: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2022 401k membership
Total participants, beginning-of-year 2022-07-01 368
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 0
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 0
Number of employers contributing to the scheme 2022-07-01 0
2021: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2021 401k membership
Total participants, beginning-of-year 2021-07-01 220
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 368
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 368
Number of employers contributing to the scheme 2021-07-01 0
2020: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2020 401k membership
Total participants, beginning-of-year 2020-07-01 159
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 220
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 220
2019: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2019 401k membership
Total participants, beginning-of-year 2019-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 158
Number of retired or separated participants receiving benefits 2019-07-01 1
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 159

Measure	Date	Value
2022: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2022 401k membership
Total participants, beginning-of-year	2022-07-01	368
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	0
Number of retired or separated participants receiving benefits	2022-07-01	0
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	0
Number of employers contributing to the scheme	2022-07-01	0
2021: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2021 401k membership
Total participants, beginning-of-year	2021-07-01	220
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	368
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	368
Number of employers contributing to the scheme	2021-07-01	0
2020: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2020 401k membership
Total participants, beginning-of-year	2020-07-01	159
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	220
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	220
2019: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2019 401k membership
Total participants, beginning-of-year	2019-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	158
Number of retired or separated participants receiving benefits	2019-07-01	1
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	159

Form 5500 Responses for EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC

2022: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	This submission is the final filing	Yes
2022-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	No
2020-07-01	This submission is the final filing	No
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-07-01	Plan is a collectively bargained plan	No
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: EMPLOYEE MEDICAL BENEFIT PLAN OF CA CAPITAL OPERATIONS LLC 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	First time form 5500 has been submitted	Yes
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

282417

Policy instance

Insurance contract or identification number	282417
Number of Individuals Covered	401
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $81,773
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,521,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,773
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

282417

Policy instance

Insurance contract or identification number	282417
Number of Individuals Covered	368
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $148,190
Total amount of fees paid to insurance company	USD $6,012
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,831,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $148,001
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

282417

Policy instance

Insurance contract or identification number	282417
Number of Individuals Covered	295
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $130,618
Total amount of fees paid to insurance company	USD $3,543
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	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
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 $2,396,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $120,088
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

282417

Policy instance

Insurance contract or identification number	282417
Number of Individuals Covered	188
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $90,817
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	No
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 $2,482,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $90,817
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	CA CAPITAL OPERATIONS LLC
Employer identification number (EIN):	271460592
NAIC Classification:	531390
NAIC Description:	Other Activities Related to Real Estate

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	201001510340