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| Plan Name | ASH STEVENS, LLC HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ASH STEVENS, LLC |
| Employer identification number (EIN): | 381715886 |
| NAIC Classification: | 325410 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-04-01 | ZACH EVERINGHAM | 2023-01-09 | ||
| 501 | 2021-01-01 | SHANNON HUVER | 2022-01-11 | ||
| 501 | 2021-01-01 | SHANNON HUVER | 2022-01-07 | ||
| 501 | 2021-01-01 | ZACH EVERINGHAM | 2023-01-09 | ||
| 501 | 2020-01-01 | SHANNON HUVER | 2021-07-29 | ||
| 501 | 2019-01-01 | SHANNON HUVER | 2020-06-03 |
| 2021: ASH STEVENS, LLC HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | Submission has been amended | No |
| 2021-04-01 | This submission is the final filing | Yes |
| 2021-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-04-01 | Plan is a collectively bargained plan | No |
| 2021-04-01 | Plan funding arrangement – Insurance | Yes |
| 2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 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 | Yes |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: ASH STEVENS, LLC HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: ASH STEVENS, LLC HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | First time form 5500 has been submitted | Yes |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 9736 |
| Policy instance | 6 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 139083 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 139083 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 2773 |
| Policy instance | 3 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 924051 |
| Policy instance | 4 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 308995 |
| Policy instance | 5 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 139083 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 2773 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249111 00000 |
| Policy instance | 4 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 8442 |
| Policy instance | 5 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249113 00000 |
| Policy instance | 6 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249112 00000 |
| Policy instance | 7 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 400001000 24751 |
| Policy instance | 8 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 403007218 |
| Policy instance | 9 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | ACC-0000001372 |
| Policy instance | 10 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 139083 |
| Policy instance | 1 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 403007218 |
| Policy instance | 9 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 400001000 24751 |
| Policy instance | 8 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 139083 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 139083 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 2773 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249111 00000 |
| Policy instance | 4 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 8442 |
| Policy instance | 5 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249113 00000 |
| Policy instance | 6 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249112 00000 |
| Policy instance | 7 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 139083 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 2773 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249111 00000 |
| Policy instance | 4 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 8442 |
| Policy instance | 5 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249113 00000 |
| Policy instance | 6 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10249112 00000 |
| Policy instance | 7 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 400001000 24751 |
| Policy instance | 8 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 139083 |
| Policy instance | 1 |
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