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| Plan Name | PROYOUTH |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PRO-YOUTH |
| Employer identification number (EIN): | 770337714 |
| NAIC Classification: | 611000 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-12-01 | MARIE PINTO | 2023-04-10 | ||
| 501 | 2020-12-01 | MARIE PINTO | 2022-04-12 |
| Measure | Date | Value |
|---|---|---|
| 2021: PROYOUTH 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-12-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 110 |
| Number of retired or separated participants receiving benefits | 2021-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 0 |
| Total of all active and inactive participants | 2021-12-01 | 110 |
| Number of employers contributing to the scheme | 2021-12-01 | 0 |
| 2020: PROYOUTH 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-12-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 106 |
| Number of retired or separated participants receiving benefits | 2020-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 0 |
| Total of all active and inactive participants | 2020-12-01 | 106 |
| Number of employers contributing to the scheme | 2020-12-01 | 0 |
| 2021: PROYOUTH 2021 form 5500 responses | ||
|---|---|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: PROYOUTH 2020 form 5500 responses | ||
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | First time form 5500 has been submitted | Yes |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) | |||||||||||||||||||||||||||
| Policy contract number | W0067543 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) | |||||||||||||||||||||||||||
| Policy contract number | W0067543 | ||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||
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| BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) | |||||||||||||||||||||||||||
| Policy contract number | W0067543 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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