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| Plan Name | UNBRIDLED SOLUTIONS MEDICAL DENTAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | UNBRIDLED SOLUTIONS, LLC |
| Employer identification number (EIN): | 841605545 |
| NAIC Classification: | 541600 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | DIANE RUDOLPH | 2024-05-10 | ||
| 501 | 2022-01-01 | DIANE RUDOLPH | 2023-04-12 | ||
| 501 | 2021-01-01 | DIANE RUDOLPH | 2022-05-06 | ||
| 501 | 2020-01-01 | DIANE RUDOLPH | 2021-05-28 | ||
| 501 | 2019-01-01 | DIANE RUDOLPH | 2020-08-27 |
| 2023: UNBRIDLED SOLUTIONS MEDICAL DENTAL 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: UNBRIDLED SOLUTIONS MEDICAL DENTAL 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: UNBRIDLED SOLUTIONS MEDICAL DENTAL 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: UNBRIDLED SOLUTIONS MEDICAL DENTAL 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: UNBRIDLED SOLUTIONS MEDICAL DENTAL PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | First time form 5500 has been submitted | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 627985 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 627985 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| |||||||||||||||||||||
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 627985 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 627985 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||
| Policy contract number | 915599 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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