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SUSSEX IM, INC. HEALTH PLAN 401k Plan overview

Plan NameSUSSEX IM, INC. HEALTH PLAN
Plan identification number 502

SUSSEX IM, INC. HEALTH PLAN Benefits

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

401k Sponsoring company profile

SUSSEX IM, INC. has sponsored the creation of one or more 401k plans.

Company Name:SUSSEX IM, INC.
Employer identification number (EIN):900508625
NAIC Classification:326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUSSEX IM, INC. HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01DAVID GUAGLIARDO DAVID GUAGLIARDO2018-10-15
5022016-01-01DAVID GUAGLIARDO DAVID GUAGLIARDO2017-10-11
5022015-01-01DAVID GUAGLIARDO DAVID GUAGLIARDO2016-10-17
5022014-01-01DAVID GUAGLIARDO DAVID GUAGLIARDO2015-10-14
5022013-01-01DAVID GUAGLIARDO
5022012-01-01DAVID GUAGLIARDO DAVID GUAGLIARDO2013-10-10
5022011-01-01DAVID GUAGLIARDO

Plan Statistics for SUSSEX IM, INC. HEALTH PLAN

401k plan membership statisitcs for SUSSEX IM, INC. HEALTH PLAN

Measure Date Value
2021: SUSSEX IM, INC. HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01227
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
2020: SUSSEX IM, INC. HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01235
Total number of active participants reported on line 7a of the Form 55002020-01-01223
Number of retired or separated participants receiving benefits2020-01-012
Total of all active and inactive participants2020-01-01225
Total participants2020-01-01225
2019: SUSSEX IM, INC. HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01247
Total number of active participants reported on line 7a of the Form 55002019-01-01227
Total of all active and inactive participants2019-01-01227
Total participants2019-01-01227
2018: SUSSEX IM, INC. HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01287
Total number of active participants reported on line 7a of the Form 55002018-01-01251
Total of all active and inactive participants2018-01-01251
2017: SUSSEX IM, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01111
Total number of active participants reported on line 7a of the Form 55002017-01-01275
Total of all active and inactive participants2017-01-01275
2016: SUSSEX IM, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01140
Total number of active participants reported on line 7a of the Form 55002016-01-01111
Total of all active and inactive participants2016-01-01111
2015: SUSSEX IM, INC. HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01140
Total number of active participants reported on line 7a of the Form 55002015-01-01140
Total of all active and inactive participants2015-01-01140
Total participants2015-01-01140
2014: SUSSEX IM, INC. HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01180
Total number of active participants reported on line 7a of the Form 55002014-01-01180
Total of all active and inactive participants2014-01-01180
Total participants2014-01-01180
2013: SUSSEX IM, INC. HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01183
Total number of active participants reported on line 7a of the Form 55002013-01-01183
Total of all active and inactive participants2013-01-01183
Total participants2013-01-01183
Number of participants with account balances2013-01-01174
2012: SUSSEX IM, INC. HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01182
Total number of active participants reported on line 7a of the Form 55002012-01-01185
Total of all active and inactive participants2012-01-01185
Total participants2012-01-01185
2011: SUSSEX IM, INC. HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01171
Total number of active participants reported on line 7a of the Form 55002011-01-01170
Number of retired or separated participants receiving benefits2011-01-011
Total of all active and inactive participants2011-01-01171
Total participants2011-01-01171

Form 5500 Responses for SUSSEX IM, INC. HEALTH PLAN

2021: SUSSEX IM, INC. HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingYes
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: SUSSEX IM, INC. HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: SUSSEX IM, INC. HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: SUSSEX IM, INC. HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: SUSSEX IM, INC. HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: SUSSEX IM, INC. HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: SUSSEX IM, INC. HEALTH PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01First time form 5500 has been submittedYes
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: SUSSEX IM, INC. HEALTH PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: SUSSEX IM, INC. HEALTH PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: SUSSEX IM, INC. HEALTH PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: SUSSEX IM, INC. HEALTH PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

WISCONSIN COLLABORATIVE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 15929 )
Policy contract numberW80430
Policy instance 1
Insurance contract or identification numberW80430
Number of Individuals Covered414
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $262,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WISCONSIN COLLABORATIVE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 15929 )
Policy contract numberW80430
Policy instance 1
Insurance contract or identification numberW80430
Number of Individuals Covered419
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $290,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPCARE HEALTH SERVICES INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95693 )
Policy contract number00242067
Policy instance 1
Insurance contract or identification number00242067
Number of Individuals Covered462
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $491,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPCARE HEALTH SERVICES INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95693 )
Policy contract number00242067
Policy instance 1
Insurance contract or identification number00242067
Number of Individuals Covered519
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $746,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPCARE HEALTH SERVICES INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95693 )
Policy contract number
Policy instance 1
Number of Individuals Covered140
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $340,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPCARE HEALTH SERVICES INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95693 )
Policy contract number
Policy instance 1
Number of Individuals Covered180
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $296,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number717890
Policy instance 1
Insurance contract or identification number717890
Number of Individuals Covered174
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $304,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number717890
Policy instance 1
Insurance contract or identification number717890
Number of Individuals Covered185
Insurance policy start date2012-01-01
Insurance policy end date2013-12-31
Welfare Benefit Premiums Paid to CarrierUSD $259,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker name
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number717890
Policy instance 1
Insurance contract or identification number717890
Number of Individuals Covered178
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Welfare Benefit Premiums Paid to CarrierUSD $233,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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