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| Plan Name | LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS GROUP HEATH AND WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS |
| Employer identification number (EIN): | 383256753 |
| NAIC Classification: | 713200 |
| NAIC Description: | Gambling Industries |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2012-06-01 | CONNIE KALLBERG | |||
| 501 | 2011-06-01 | LISA SCOTT | |||
| 501 | 2009-06-01 | PATRICK GARRISON |
| Measure | Date | Value |
|---|---|---|
| 2012: LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS GROUP HEATH AND WELFARE BENEFIT PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-06-01 | 220 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 206 |
| Total of all active and inactive participants | 2012-06-01 | 206 |
| 2011: LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS GROUP HEATH AND WELFARE BENEFIT PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-06-01 | 280 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 220 |
| Total of all active and inactive participants | 2011-06-01 | 220 |
| 2009: LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS GROUP HEATH AND WELFARE BENEFIT PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-06-01 | 208 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 205 |
| Number of retired or separated participants receiving benefits | 2009-06-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2009-06-01 | 0 |
| Total of all active and inactive participants | 2009-06-01 | 208 |
| 2012: LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS GROUP HEATH AND WELFARE BENEFIT PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-06-01 | Type of plan entity | Single employer plan |
| 2012-06-01 | Plan funding arrangement – Insurance | Yes |
| 2012-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS GROUP HEATH AND WELFARE BENEFIT PLAN 2011 form 5500 responses | ||
| 2011-06-01 | Type of plan entity | Single employer plan |
| 2011-06-01 | Plan funding arrangement – Insurance | Yes |
| 2011-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: LAC VIEUX DESERT BAND OF LAKE SUPERIOR CHIPPEWA INDIANS GROUP HEATH AND WELFARE BENEFIT PLAN 2009 form 5500 responses | ||
| 2009-06-01 | Type of plan entity | Single employer plan |
| 2009-06-01 | Submission has been amended | No |
| 2009-06-01 | This submission is the final filing | No |
| 2009-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-06-01 | Plan is a collectively bargained plan | No |
| 2009-06-01 | Plan funding arrangement – Insurance | Yes |
| 2009-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 117039 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 117039 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 113 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 117039 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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