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| Plan Name | AQUA LUNG AMERICA WELFARE BENEFIT PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | AQUA LUNG AMERICA |
| Employer identification number (EIN): | 330237183 |
| NAIC Classification: | 326200 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2019-06-01 | ||||
| 504 | 2018-06-01 | ||||
| 504 | 2017-08-01 | MELISSA STEWART | |||
| 504 | 2016-08-01 | LIGAYA BOWMAN | LIGAYA BOWMAN | 2018-05-06 | |
| 504 | 2015-08-01 | LIGAYA BOWMAN | |||
| 504 | 2014-08-01 | LIGAYA BOWMAN | |||
| 504 | 2013-08-01 | LIGAYA BOWMAN | |||
| 504 | 2012-08-01 | RAMONA POWELL | |||
| 504 | 2011-08-01 | RAMONA POWELL | RAMONA POWELL | 2013-05-10 | |
| 504 | 2010-08-01 | RAMONA POWELL | |||
| 504 | 2009-08-01 | RAMONA POWELL |
| 2019: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-06-01 | Type of plan entity | Single employer plan |
| 2019-06-01 | Submission has been amended | No |
| 2019-06-01 | This submission is the final filing | No |
| 2019-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-06-01 | Plan is a collectively bargained plan | No |
| 2019-06-01 | Plan funding arrangement – Insurance | Yes |
| 2019-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2018 form 5500 responses | ||
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Submission has been amended | No |
| 2018-06-01 | This submission is the final filing | No |
| 2018-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-06-01 | Plan is a collectively bargained plan | No |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2017 form 5500 responses | ||
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Submission has been amended | No |
| 2017-08-01 | This submission is the final filing | No |
| 2017-08-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-08-01 | Plan is a collectively bargained plan | No |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Submission has been amended | No |
| 2016-08-01 | This submission is the final filing | No |
| 2016-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-08-01 | Plan is a collectively bargained plan | No |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2015 form 5500 responses | ||
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Submission has been amended | No |
| 2015-08-01 | This submission is the final filing | No |
| 2015-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-08-01 | Plan is a collectively bargained plan | No |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2014 form 5500 responses | ||
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Submission has been amended | No |
| 2014-08-01 | This submission is the final filing | No |
| 2014-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-08-01 | Plan is a collectively bargained plan | No |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2013 form 5500 responses | ||
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Submission has been amended | No |
| 2013-08-01 | This submission is the final filing | No |
| 2013-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-08-01 | Plan is a collectively bargained plan | No |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2012 form 5500 responses | ||
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Submission has been amended | No |
| 2012-08-01 | This submission is the final filing | No |
| 2012-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-08-01 | Plan is a collectively bargained plan | No |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2011 form 5500 responses | ||
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Submission has been amended | No |
| 2011-08-01 | This submission is the final filing | No |
| 2011-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-08-01 | Plan is a collectively bargained plan | No |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2010 form 5500 responses | ||
| 2010-08-01 | Type of plan entity | Single employer plan |
| 2010-08-01 | Submission has been amended | No |
| 2010-08-01 | This submission is the final filing | No |
| 2010-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-08-01 | Plan is a collectively bargained plan | No |
| 2010-08-01 | Plan funding arrangement – Insurance | Yes |
| 2010-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: AQUA LUNG AMERICA WELFARE BENEFIT PLAN 2009 form 5500 responses | ||
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Submission has been amended | No |
| 2009-08-01 | This submission is the final filing | No |
| 2009-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-08-01 | Plan is a collectively bargained plan | No |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 914566 |
| Policy instance | 11 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VG185784 |
| Policy instance | 1 |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |
| Policy contract number | 275159 |
| Policy instance | 2 |
| DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 ) | |
| Policy contract number | 5311H |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAI826403 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL156343 |
| Policy instance | 5 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 32907 |
| Policy instance | 6 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | 136-007970 |
| Policy instance | 7 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VCI801292 |
| Policy instance | 8 |
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 ) | |
| Policy contract number | 719 |
| Policy instance | 9 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VPL302833 |
| Policy instance | 10 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VCI801292 |
| Policy instance | 11 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAI826403 |
| Policy instance | 10 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VG185784 |
| Policy instance | 9 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | 136-007970 |
| Policy instance | 8 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 32907 |
| Policy instance | 7 |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |
| Policy contract number | 275159 |
| Policy instance | 1 |
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 ) | |
| Policy contract number | 719 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VPL302833 |
| Policy instance | 3 |
| DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 ) | |
| Policy contract number | 5311H |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL156343 |
| Policy instance | 5 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 914566 |
| Policy instance | 6 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 32907 |
| Policy instance | 2 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05928540 |
| Policy instance | 3 |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |
| Policy contract number | 275159 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | 136-007970 |
| Policy instance | 5 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05928540 |
| Policy instance | 6 |
| SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 ) | |
| Policy contract number | 719 |
| Policy instance | 7 |
| DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 ) | |
| Policy contract number | 5311H |
| Policy instance | 8 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL156343 |
| Policy instance | 1 |
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