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| Plan Name | EXTENSIV HEALTH & WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | EXTENSIV |
| Employer identification number (EIN): | 208830242 |
| NAIC Classification: | 541511 |
| NAIC Description: | Custom Computer Programming Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2024-04-01 | JENNIFER ALBERT | |||
| 501 | 2023-04-01 | ||||
| 501 | 2023-04-01 | JENNIFER ALBERT | |||
| 501 | 2022-04-01 | ||||
| 501 | 2022-04-01 | JENNIFER ALBERT |
| Measure | Date | Value |
|---|---|---|
| 2023: EXTENSIV HEALTH & WELFARE PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-04-01 | 212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-04-01 | 188 |
| Number of retired or separated participants receiving benefits | 2023-04-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2023-04-01 | 0 |
| Total of all active and inactive participants | 2023-04-01 | 189 |
| 2022: EXTENSIV HEALTH & WELFARE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-04-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 209 |
| Number of retired or separated participants receiving benefits | 2022-04-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
| Total of all active and inactive participants | 2022-04-01 | 212 |
| 2023: EXTENSIV HEALTH & WELFARE PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-04-01 | Type of plan entity | Single employer plan |
| 2023-04-01 | Submission has been amended | No |
| 2023-04-01 | This submission is the final filing | No |
| 2023-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-04-01 | Plan is a collectively bargained plan | No |
| 2023-04-01 | Plan funding arrangement – Insurance | Yes |
| 2023-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: EXTENSIV HEALTH & WELFARE PLAN 2022 form 5500 responses | ||
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | First time form 5500 has been submitted | Yes |
| 2022-04-01 | Submission has been amended | No |
| 2022-04-01 | This submission is the final filing | No |
| 2022-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-04-01 | Plan is a collectively bargained plan | No |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 235768 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | 3344973 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5395024 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5395024 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 235768 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 3344973 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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