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| Plan Name | APPVION, INC. GROUP MEDICAL PLAN |
| Plan identification number | 548 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | APPVION, LLC |
| Employer identification number (EIN): | 873735970 |
| NAIC Classification: | 322200 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 548 | 2023-01-01 | RACHEL KRUSZKA | 2024-08-21 | ||
| 548 | 2022-01-01 | RACHEL KRUSZKA | 2023-10-11 |
| Measure | Date | Value |
|---|---|---|
| 2023: APPVION, INC. GROUP MEDICAL PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-01-01 | 534 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 0 |
| Number of employers contributing to the scheme | 2023-01-01 | 0 |
| 2022: APPVION, INC. GROUP MEDICAL PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 756 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 295 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 252 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 25 |
| Total of all active and inactive participants | 2022-01-01 | 572 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2023: APPVION, INC. GROUP MEDICAL PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | This submission is the final filing | Yes |
| 2023-01-01 | Plan is a collectively bargained plan | Yes |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: APPVION, INC. GROUP MEDICAL PLAN 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan is a collectively bargained plan | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| EMPHESYS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88595 ) | |||||||||||||||||||||||||||
| Policy contract number | 620933 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||
| Policy contract number | 2722A | ||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||
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| EMPHESYS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88595 ) | |||||||||||||||||||||||||||
| Policy contract number | 620933 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||
| Policy contract number | 2722A | ||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||
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