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| Plan Name | IMSAR HEALTH & WELFARE BENEFIT PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | IMSAR LLC |
| Employer identification number (EIN): | 201853461 |
| NAIC Classification: | 334500 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2021-01-01 | JENY GRIERSON | 2022-07-20 | LARRY MOORE | 2022-07-20 |
| Measure | Date | Value |
|---|---|---|
| 2021: IMSAR HEALTH & WELFARE BENEFIT PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 100 |
| Total of all active and inactive participants | 2021-01-01 | 100 |
| Total participants | 2021-01-01 | 100 |
| 2021: IMSAR HEALTH & WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 00624627 |
| Policy instance | 1 |
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) | |
| Policy contract number | 664644 |
| Policy instance | 2 |
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