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| Plan Name | HEALTH-DENTAL-VISION |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ARANDELL CORPORATION |
| Employer identification number (EIN): | 853986525 |
| NAIC Classification: | 323100 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2021-04-01 | KIMBERLY KOZLIK | 2023-01-17 | ||
| 503 | 2020-04-01 | BRIAN ULRICH | 2022-01-18 |
| Measure | Date | Value |
|---|---|---|
| 2021: HEALTH-DENTAL-VISION 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-04-01 | 395 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 374 |
| Number of retired or separated participants receiving benefits | 2021-04-01 | 5 |
| Total of all active and inactive participants | 2021-04-01 | 379 |
| 2020: HEALTH-DENTAL-VISION 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-04-01 | 473 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 389 |
| Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 6 |
| Total of all active and inactive participants | 2020-04-01 | 395 |
| 2021: HEALTH-DENTAL-VISION 2021 form 5500 responses | ||
|---|---|---|
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | Plan is a collectively bargained plan | Yes |
| 2021-04-01 | Plan funding arrangement – Insurance | Yes |
| 2021-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: HEALTH-DENTAL-VISION 2020 form 5500 responses | ||
| 2020-04-01 | Type of plan entity | Single employer plan |
| 2020-04-01 | Plan is a collectively bargained plan | Yes |
| 2020-04-01 | Plan funding arrangement – Insurance | Yes |
| 2020-04-01 | Plan benefit arrangement – Insurance | Yes |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) | |
| Policy contract number | 417009410857 |
| Policy instance | 1 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 938333 |
| Policy instance | 2 |
| SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 ) | |
| Policy contract number | 800014 |
| Policy instance | 3 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) | |
| Policy contract number | 417009410857 |
| Policy instance | 1 |
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