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SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 501

SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

COMMUNITY COLLABORATIVE VIRTUAL SCHOOL has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY COLLABORATIVE VIRTUAL SCHOOL
Employer identification number (EIN):474121914
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-07-01KRISTA WOODGRIFT2025-01-10
5012022-07-01KRISTA WOODGRIFT2024-01-29 KRISTA WOODGRIFT2024-01-29

Plan Statistics for SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2023: SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-07-01242
Total number of active participants reported on line 7a of the Form 55002023-07-01313
Number of retired or separated participants receiving benefits2023-07-010
Number of other retired or separated participants entitled to future benefits2023-07-010
Total of all active and inactive participants2023-07-01313
Number of employers contributing to the scheme2023-07-010
2022: SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01246
Total number of active participants reported on line 7a of the Form 55002022-07-01284
Number of retired or separated participants receiving benefits2022-07-011
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01285

Form 5500 Responses for SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN

2023: SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-07-01Type of plan entitySingle employer plan
2023-07-01Plan funding arrangement – InsuranceYes
2023-07-01Plan funding arrangement – General assets of the sponsorYes
2023-07-01Plan benefit arrangement – InsuranceYes
2023-07-01Plan benefit arrangement – General assets of the sponsorYes
2022: SAGE OAK CHARTER SCHOOLS HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01First time form 5500 has been submittedYes
2022-07-01Submission has been amendedNo
2022-07-01This submission is the final filingNo
2022-07-01This return/report is a short plan year return/report (less than 12 months)No
2022-07-01Plan is a collectively bargained planNo
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3345083
Policy instance 1
Insurance contract or identification number3345083
Number of Individuals Covered227
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $100,816
Total amount of fees paid to insurance companyUSD $38,825
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,764,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number235839
Policy instance 2
Insurance contract or identification number235839
Number of Individuals Covered382
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $104,404
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,943,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0C5KZ
Policy instance 3
Insurance contract or identification numberGLUG0C5KZ
Number of Individuals Covered313
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $6,140
Total amount of fees paid to insurance companyUSD $1,958
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, CRITICAL ILLNESS, ACCIDENT, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $54,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number235839
Policy instance 1
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3345083
Policy instance 2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0C5KZ
Policy instance 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0C5KZ
Policy instance 4
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract numberE5846464
Policy instance 5
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract numberE5748496
Policy instance 6

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