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| Plan Name | CALZEDONIA VOLUNTARY LIFE PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CALZEDONIA USA INC |
| Employer identification number (EIN): | 383988701 |
| NAIC Classification: | 812990 |
| NAIC Description: | All Other Personal Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2021-01-01 | DIANA BORY | 2022-09-26 |
| 2021: CALZEDONIA VOLUNTARY LIFE PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) | |
| Policy contract number | 659885 |
| Policy instance | 1 |
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