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THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 401k Plan overview

Plan NameTHE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN
Plan identification number 505

THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Vision

401k Sponsoring company profile

THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC. has sponsored the creation of one or more 401k plans.

Company Name:THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC.
Employer identification number (EIN):751835298
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2014-11-19
Company Identification Number: 106329899

More information about THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052018-01-01CATHERINE OLIVIERI2019-07-25
5052017-01-01
5052016-01-01ROBERT GREEN
5052015-01-01ROBERT GREEN
5052014-01-01BOB GREEN
5052013-01-01KAY E. MERRELL
5052012-01-01KAY MERRELL
5052011-01-01KAY ROHLMAN
5052010-01-01KAY ROHLMAN
5052009-01-01KAY E ROHLMAN KAY E ROHLMAN2010-06-07

Plan Statistics for THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN

401k plan membership statisitcs for THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN

Measure Date Value
2018: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01176
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
Number of employers contributing to the scheme2018-01-010
2017: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01229
Total number of active participants reported on line 7a of the Form 55002017-01-01183
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01183
2016: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01226
Total number of active participants reported on line 7a of the Form 55002016-01-01229
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-014
Total of all active and inactive participants2016-01-01234
2015: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01213
Total number of active participants reported on line 7a of the Form 55002015-01-01224
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01224
2014: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01205
Total number of active participants reported on line 7a of the Form 55002014-01-01215
Number of retired or separated participants receiving benefits2014-01-013
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01218
2013: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01251
Total number of active participants reported on line 7a of the Form 55002013-01-01215
Number of retired or separated participants receiving benefits2013-01-0116
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01231
2012: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01273
Total number of active participants reported on line 7a of the Form 55002012-01-01236
Number of retired or separated participants receiving benefits2012-01-0115
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01251
2011: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01254
Total number of active participants reported on line 7a of the Form 55002011-01-01269
Number of retired or separated participants receiving benefits2011-01-014
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01273
2010: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01214
Total number of active participants reported on line 7a of the Form 55002010-01-01250
Number of retired or separated participants receiving benefits2010-01-014
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01254
2009: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01209
Total number of active participants reported on line 7a of the Form 55002009-01-01205
Number of retired or separated participants receiving benefits2009-01-019
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01214

Form 5500 Responses for THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN

2018: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01This submission is the final filingYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
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: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: THE SUSAN G KOMEN BREAST CANCER FOUNDATION VISION PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 1
Insurance contract or identification number27502
Number of Individuals Covered350
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,581
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,581
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 1
Insurance contract or identification number27502
Number of Individuals Covered333
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,794
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,794
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 1
Insurance contract or identification number27502
Number of Individuals Covered384
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,962
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $32,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,962
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 1
Insurance contract or identification number27502
Number of Individuals Covered374
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,748
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $31,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,748
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 1
Insurance contract or identification number27502
Number of Individuals Covered374
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,428
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $37,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,428
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 1
Insurance contract or identification number27502
Number of Individuals Covered236
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,502
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $41,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,502
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 1
Insurance contract or identification number27502
Number of Individuals Covered273
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,291
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $40,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 1
Insurance contract or identification number27502
Number of Individuals Covered250
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,237
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $37,748
Commission paid to Insurance BrokerUSD $1,150
Insurance broker organization code?3
Insurance broker nameWILLIS OF TEXAS, INC

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