| Plan Name | SAMARITAN HOUSE HEALTH & WELFARE BENEFIT PLAN |
| Plan identification number | 511 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | SAMARITAN HOUSE |
| Employer identification number (EIN): | 237416272 |
| NAIC Classification: | 624200 |
Additional information about SAMARITAN HOUSE
| Jurisdiction of Incorporation: | California Department of State |
| Incorporation Date: | |
| Company Identification Number: | C0727612 |
More information about SAMARITAN HOUSE
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 511 | 2022-12-01 | JOLIE BOU | 2024-06-28 |
| 2022: SAMARITAN HOUSE HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-12-01 | Type of plan entity | Single employer plan |
| 2022-12-01 | First time form 5500 has been submitted | Yes |
| 2022-12-01 | Submission has been amended | No |
| 2022-12-01 | This submission is the final filing | No |
| 2022-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-12-01 | Plan is a collectively bargained plan | No |
| 2022-12-01 | Plan funding arrangement – Insurance | Yes |
| 2022-12-01 | Plan benefit arrangement – Insurance | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 147112 |
| Policy instance | 3 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 649328 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05954837 |
| Policy instance | 2 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |
| Policy contract number | GLTD0BFW7 |
| Policy instance | 4 |