401k Plan data: HOSPITAL INDEMNITY PLAN plan

HOSPITAL INDEMNITY PLAN 401k Plan overview

Plan Name	HOSPITAL INDEMNITY PLAN
Plan identification number	526

HOSPITAL INDEMNITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Other welfare benefit cover

401k Sponsoring company profile

CIGNA HOLDING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: CIGNA HOLDING COMPANY

Employer identification number (EIN): 061059331

NAIC Classification: 524290

Additional information about CIGNA HOLDING COMPANY

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 0925609

More information about CIGNA HOLDING COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITAL INDEMNITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
526 2017-01-01 ALICIA VASLOW

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
526	2017-01-01	ALICIA VASLOW

Plan Statistics for HOSPITAL INDEMNITY PLAN

401k plan membership statisitcs for HOSPITAL INDEMNITY PLAN

Measure Date Value
2017: HOSPITAL INDEMNITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0

Measure	Date	Value
2017: HOSPITAL INDEMNITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0

Form 5500 Responses for HOSPITAL INDEMNITY PLAN

2017: HOSPITAL INDEMNITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

HC960010

Policy instance

Insurance contract or identification number	HC960010
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
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	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	HOSPITAL CARE
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 $858,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	CIGNA HOLDING COMPANY
Employer identification number (EIN):	061059331
NAIC Classification:	524290

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	0925609