401k Plan data: 3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN plan

3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN
Plan identification number	503

3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

3 RIVERS TELEPHONE COOPERATIVE, INC. has sponsored the creation of one or more 401k plans.

Company Name: 3 RIVERS TELEPHONE COOPERATIVE, INC.

Employer identification number (EIN): 810243702

NAIC Classification: 517000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2024-01-01 EMILY A. GULICK
503 2023-01-01
503 2023-01-01 EMILY A. GULICK
503 2022-01-01
503 2022-01-01 EMILY A. GULICK
503 2021-01-01
503 2021-01-01 DAVID M. MASSEY

Form 5500 Responses for 3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN

2023: 3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Mulitple employer plan
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: 3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Mulitple employer plan
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: 3 RIVERS TELEPHONE COOPERATIVE INC. HEALTH & WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Mulitple employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )

Policy contract number

L23101809

Policy instance

Insurance contract or identification number	L23101809
Number of Individuals Covered	174
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $22,141
Welfare Benefit Premiums Paid to Carrier	USD $553,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GENWORTH LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70025 )

Policy contract number

19727

Policy instance

Insurance contract or identification number	19727
Number of Individuals Covered	30
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,108
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG-TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $7,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1039945

Policy instance

Insurance contract or identification number	1039945
Number of Individuals Covered	53
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,882
Total amount of fees paid to insurance company	USD $602
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1051194

Policy instance

Insurance contract or identification number	1051194
Number of Individuals Covered	373
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $9,619
Total amount of fees paid to insurance company	USD $3,856
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $154,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GENWORTH LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70025 )

Policy contract number

13015

Policy instance

Insurance contract or identification number	13015
Number of Individuals Covered	113
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,990
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG-TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $42,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 )

Policy contract number

1100000089

Policy instance

Insurance contract or identification number	1100000089
Number of Individuals Covered	61
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,155
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $19,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15015148

Policy instance

Insurance contract or identification number	15015148
Number of Individuals Covered	123
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $3,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 19682 )

Policy contract number

GTA101943

Policy instance

Insurance contract or identification number	GTA101943
Number of Individuals Covered	178
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $431
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GENWORTH LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70025 )

Policy contract number

19727

Policy instance

Insurance contract or identification number	19727
Number of Individuals Covered	21
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,434
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG-TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $5,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL36978

Policy instance

Insurance contract or identification number	HCL36978
Number of Individuals Covered	178
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $20,600
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $515,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15015148

Policy instance

Insurance contract or identification number	15015148
Number of Individuals Covered	123
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $2,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

BTA-37420

Policy instance

Insurance contract or identification number	BTA-37420
Number of Individuals Covered	138
Insurance policy start date	2022-01-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $85
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 )

Policy contract number

1100000089

Policy instance

Insurance contract or identification number	1100000089
Number of Individuals Covered	59
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,021
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $19,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GENWORTH LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70025 )

Policy contract number

13015

Policy instance

Insurance contract or identification number	13015
Number of Individuals Covered	117
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,890
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG-TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $44,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1051194

Policy instance

Insurance contract or identification number	1051194
Number of Individuals Covered	348
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,175
Total amount of fees paid to insurance company	USD $2,354
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1039945

Policy instance

Insurance contract or identification number	1039945
Number of Individuals Covered	55
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,008
Total amount of fees paid to insurance company	USD $372
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1039945

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1051194

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

SLM540364

Policy instance

GENWORTH LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70025 )

Policy contract number

13015

Policy instance

ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 )

Policy contract number

1100000089

Policy instance

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

BTA-37420

Policy instance

RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15015148

Policy instance

GENWORTH LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70025 )

Policy contract number

19727

Policy instance

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Company Name:	3 RIVERS TELEPHONE COOPERATIVE, INC.
Employer identification number (EIN):	810243702
NAIC Classification:	517000

Plan id#	Filing Submission Date	Name of Administrator
503	2024-01-01	EMILY A. GULICK
503	2023-01-01
503	2023-01-01	EMILY A. GULICK
503	2022-01-01
503	2022-01-01	EMILY A. GULICK
503	2021-01-01
503	2021-01-01	DAVID M. MASSEY