| Plan Name | HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FORTIS LIFE SCIENCES LLC |
| Employer identification number (EIN): | 853268510 |
| NAIC Classification: | 541700 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-06-01 | APRIL LANGFORD | 2024-10-21 | ||
| 501 | 2022-06-01 | APRIL LANGFORD | 2023-12-11 |
| 2023: HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-06-01 | Type of plan entity | Single employer plan |
| 2023-06-01 | Plan funding arrangement – Insurance | Yes |
| 2023-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | First time form 5500 has been submitted | Yes |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||
| Policy contract number | 3345050 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) | |||||||||||||||||||||||||
| Policy contract number | 01-020461-00 | ||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||
| Policy contract number | 235723 | ||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||
| |||||||||||||||||||||||||
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||
| Policy contract number | 3345050 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) | |||||||||||||||||||||||||
| Policy contract number | 01-020461-00 | ||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||