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| Plan Name | CITY VENTURES PROFESSIONAL SERVICES, LLC HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CITY VENTURES PROFESSIONAL SERVICES, LLC |
| Employer identification number (EIN): | 823678714 |
| NAIC Classification: | 531310 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | AMY HOWARD | 2024-10-11 | ||
| 501 | 2022-01-01 | KENNETH M WATERS | 2023-10-12 | ||
| 501 | 2021-01-01 | CAREY ELLINGHAUS | 2022-06-30 |
| 2023: CITY VENTURES PROFESSIONAL SERVICES, LLC HEALTH AND WELFARE 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 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: CITY VENTURES PROFESSIONAL SERVICES, LLC HEALTH AND WELFARE 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: CITY VENTURES PROFESSIONAL SERVICES, LLC HEALTH AND WELFARE PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||
| Policy contract number | 370416 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||
| Policy contract number | GLUG0BJ4L | ||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||||
| Policy contract number | 1093880 | ||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||
| Policy contract number | 2Y8886 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||
| Policy contract number | GVTL0BJ4L | ||||||||||||||||||||||||
| Policy instance | 6 | ||||||||||||||||||||||||
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||
| Policy contract number | GUPR0BJ4L | ||||||||||||||||||||||||
| Policy instance | 5 | ||||||||||||||||||||||||
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||
| Policy contract number | GUC 0BJ4L | ||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||
| UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||
| Policy contract number | GLUG0BJ4L | ||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||||
| Policy contract number | 1093880 | ||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||
| Policy contract number | 02Y8886 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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