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| Plan Name | ANDRETTI GROUP HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ANDRETTI GROUP |
| Employer identification number (EIN): | 814893805 |
| NAIC Classification: | 424700 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | AMANDA SEDIVY | 2024-07-26 | ||
| 501 | 2022-01-01 | AMANDA SEDIVY | 2023-07-19 | ||
| 501 | 2021-01-01 | AMANDA SEDIVY | 2022-08-01 | ||
| 501 | 2020-01-01 | AMANDA SEDIVY | 2022-08-01 | ||
| 501 | 2019-10-01 | AMANDA SEDIVY | 2022-08-01 |
| 2023: ANDRETTI GROUP HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: ANDRETTI GROUP HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: ANDRETTI GROUP HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: ANDRETTI GROUP HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: ANDRETTI GROUP HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses | ||
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | First time form 5500 has been submitted | Yes |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) | |||||||||||||||||||||||
| Policy contract number | 10043861 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||
| Policy contract number | 1116718 | ||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||
| |||||||||||||||||||||||
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) | |||||||||||||||||||||||
| Policy contract number | 10043861 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||
| Policy contract number | 1116718 | ||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) | |||||||||||||||||||||||
| Policy contract number | 10043861 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||
| Policy contract number | 1116718 | ||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||
| Policy contract number | 116718 | ||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||
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