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Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

Form 5500 Filing Information

Submission information for form 5500 for 401k plan

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-10-01ELENA COSMESCU2024-04-19 ELENA COSMESCU2024-04-19
5012021-10-01ELENA COSMESCU2023-06-30
5012020-10-01ELENA COSMESEU2022-04-21
5012019-10-01ELENA COSMESCU2021-02-22 ELENA COSMESCU2021-02-22

Plan Statistics for

401k plan membership statisitcs for

Measure Date Value
2022: 2022 401k membership
Total participants, beginning-of-year2022-10-01100
Total number of active participants reported on line 7a of the Form 55002022-10-0181
Total of all active and inactive participants2022-10-0181
Total participants2022-10-0181
2021: 2021 401k membership
Total participants, beginning-of-year2021-10-01175
Total number of active participants reported on line 7a of the Form 55002021-10-01141
Total of all active and inactive participants2021-10-01141
Total participants2021-10-01141
2020: 2020 401k membership
Total participants, beginning-of-year2020-10-01168
Total number of active participants reported on line 7a of the Form 55002020-10-01168
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01168
Total participants2020-10-01168
2019: 2019 401k membership
Total participants, beginning-of-year2019-10-01177
Total number of active participants reported on line 7a of the Form 55002019-10-01177
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01177
Total participants2019-10-01177

Form 5500 Responses for

2022: 2022 form 5500 responses
2022-10-01Type of plan entitySingle employer plan
2022-10-01Submission has been amendedNo
2022-10-01This submission is the final filingNo
2022-10-01This return/report is a short plan year return/report (less than 12 months)No
2022-10-01Plan is a collectively bargained planNo
2022-10-01Plan funding arrangement – InsuranceYes
2022-10-01Plan benefit arrangement – InsuranceYes
2021: 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Submission has been amendedYes
2021-10-01This submission is the final filingNo
2021-10-01This return/report is a short plan year return/report (less than 12 months)No
2021-10-01Plan is a collectively bargained planNo
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – InsuranceYes
2020: 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Submission has been amendedNo
2020-10-01This submission is the final filingNo
2020-10-01This return/report is a short plan year return/report (less than 12 months)No
2020-10-01Plan is a collectively bargained planNo
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes
2019: 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Submission has been amendedNo
2019-10-01This submission is the final filingNo
2019-10-01This return/report is a short plan year return/report (less than 12 months)No
2019-10-01Plan is a collectively bargained planNo
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number039584
Policy instance 1
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberGLZ AZE39938
Policy instance 2
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number039584
Policy instance 1
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number
Policy instance 2
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberGLZ AZE39938
Policy instance 1
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number039584
Policy instance 2
BANNER HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16058 )
Policy contract number0817891BH
Policy instance 1
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberGLZ AZE39938
Policy instance 2

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