401k Plan data: OKLAHOMA CHAMBER BLUE ASSOCIATION plan

OKLAHOMA CHAMBER BLUE ASSOCIATION 401k Plan overview

Plan Name	OKLAHOMA CHAMBER BLUE ASSOCIATION
Plan identification number	505

OKLAHOMA CHAMBER BLUE ASSOCIATION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

OKLAHOMA STATE CHAMBER OF COMMERCE has sponsored the creation of one or more 401k plans.

Company Name: OKLAHOMA STATE CHAMBER OF COMMERCE

Employer identification number (EIN): 731270209

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OKLAHOMA CHAMBER BLUE ASSOCIATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2019-01-01

Plan Statistics for OKLAHOMA CHAMBER BLUE ASSOCIATION

401k plan membership statisitcs for OKLAHOMA CHAMBER BLUE ASSOCIATION

Measure Date Value
2019: OKLAHOMA CHAMBER BLUE ASSOCIATION 2019 401k membership
Total participants, beginning-of-year 2019-01-01 99
Total of all active and inactive participants 2019-01-01 0

Measure	Date	Value
2019: OKLAHOMA CHAMBER BLUE ASSOCIATION 2019 401k membership
Total participants, beginning-of-year	2019-01-01	99
Total of all active and inactive participants	2019-01-01	0

Form 5500 Responses for OKLAHOMA CHAMBER BLUE ASSOCIATION

2019: OKLAHOMA CHAMBER BLUE ASSOCIATION 2019 form 5500 responses
2019-01-01	Type of plan entity	Multi-employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

232082

Policy instance

Insurance contract or identification number	232082
Number of Individuals Covered	99
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,750
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $524,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,380
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F023233

Policy instance

Insurance contract or identification number	F023233
Number of Individuals Covered	12
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $1,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	OKLAHOMA STATE CHAMBER OF COMMERCE
Employer identification number (EIN):	731270209
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services