401k Plan data: CIGNA OPEN ACCESS PLUS plan

CIGNA OPEN ACCESS PLUS 401k Plan overview

Plan Name	CIGNA OPEN ACCESS PLUS
Plan identification number	503

CIGNA OPEN ACCESS PLUS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

KIT CARSON ELECTRIC COOPERATIVE, INC. has sponsored the creation of one or more 401k plans.

Company Name: KIT CARSON ELECTRIC COOPERATIVE, INC.

Employer identification number (EIN): 850081882

NAIC Classification: 221100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CIGNA OPEN ACCESS PLUS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2018-01-01 LYNN GILLEY LYNN GILLEY 2019-07-02
503 2018-01-01 CARMELLA SUAZO 2021-10-22 CARMELLA SUAZO 2021-10-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2018-01-01	LYNN GILLEY		LYNN GILLEY	2019-07-02
503	2018-01-01	CARMELLA SUAZO	2021-10-22	CARMELLA SUAZO	2021-10-22

Plan Statistics for CIGNA OPEN ACCESS PLUS

401k plan membership statisitcs for CIGNA OPEN ACCESS PLUS

Measure Date Value
2018: CIGNA OPEN ACCESS PLUS 2018 401k membership
Total participants, beginning-of-year 2018-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 170
Total of all active and inactive participants 2018-01-01 170
Total participants 2018-01-01 170
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0

Measure	Date	Value
2018: CIGNA OPEN ACCESS PLUS 2018 401k membership
Total participants, beginning-of-year	2018-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	170
Total of all active and inactive participants	2018-01-01	170
Total participants	2018-01-01	170
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0

Form 5500 Responses for CIGNA OPEN ACCESS PLUS

2018: CIGNA OPEN ACCESS PLUS 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

621677

Policy instance

Insurance contract or identification number	621677
Number of Individuals Covered	168
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $44,819
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,119,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	44819

Potentially related plans

CIGNA OPEN ACCESS PLUS [EIN = 454039149]

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Company Name:	KIT CARSON ELECTRIC COOPERATIVE, INC.
Employer identification number (EIN):	850081882
NAIC Classification:	221100