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VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN 401k Plan overview

Plan NameVOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN
Plan identification number 515

VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Other welfare benefit cover

401k Sponsoring company profile

BLUE CROSS AND BLUE SHIELD OF NEBRASKA has sponsored the creation of one or more 401k plans.

Company Name:BLUE CROSS AND BLUE SHIELD OF NEBRASKA
Employer identification number (EIN):470095156
NAIC Classification:524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5152016-01-01CATHY FILIPIAK
5152016-01-01
5152015-09-01BRAD SCHROEDER

Plan Statistics for VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN

401k plan membership statisitcs for VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN

Measure Date Value
2016: VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01381
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-010
2015: VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01227
Total number of active participants reported on line 7a of the Form 55002015-09-01381
Number of retired or separated participants receiving benefits2015-09-010
Number of other retired or separated participants entitled to future benefits2015-09-010
Total of all active and inactive participants2015-09-01381

Form 5500 Responses for VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN

2016: VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedYes
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: VOLUNTARY CRITICAL ILLNESS AND ACCIDENT PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01First time form 5500 has been submittedYes
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 )
Policy contract number1000000155
Policy instance 1
Insurance contract or identification number1000000155
Number of Individuals Covered381
Insurance policy start date2015-09-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $13,458
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $34,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,458
Insurance broker organization code?3
Insurance broker nameSILVERSTONE GROUP, INC

Potentially related plans

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