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| Plan Name | INTEGRICHAIN, INC. MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | INTEGRICHAIN, INC. |
| Employer identification number (EIN): | 542187446 |
| NAIC Classification: | 518210 |
| NAIC Description: | Data Processing, Hosting, and Related Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | VICKIE KOZHUSHCHENKO | 2024-05-20 | ||
| 501 | 2022-01-01 | VICKIE KOZHUSHCHENKO | 2023-07-19 | ||
| 501 | 2021-01-01 | VICKIE KOZHUSHCHENKO | 2022-06-13 | ||
| 501 | 2020-01-01 | VICTORIA KOZHUSHCHENKO | 2021-07-30 |
| 2023: INTEGRICHAIN, INC. MEDICAL PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: INTEGRICHAIN, INC. MEDICAL PLAN 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: INTEGRICHAIN, INC. MEDICAL PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: INTEGRICHAIN, INC. MEDICAL PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | First time form 5500 has been submitted | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 628531 |
| Policy instance | 1 |
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