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HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN 401k Plan overview

Plan NameHUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN
Plan identification number 501

HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

CAL POLY HUMBOLDT SPONSORED PROGRAMS FOUNDATION has sponsored the creation of one or more 401k plans.

Company Name:CAL POLY HUMBOLDT SPONSORED PROGRAMS FOUNDATION
Employer identification number (EIN):946050071
NAIC Classification:611000

Additional information about CAL POLY HUMBOLDT SPONSORED PROGRAMS FOUNDATION

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0265392

More information about CAL POLY HUMBOLDT SPONSORED PROGRAMS FOUNDATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01WILLIAM COOK2023-10-10 WILLIAM COOK2023-10-10
5012021-07-01WILLIAM COOK2023-10-10 WILLIAM COOK2023-10-10

Plan Statistics for HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN

401k plan membership statisitcs for HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN

Measure Date Value
2022: HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01101
Total number of active participants reported on line 7a of the Form 55002022-07-01115
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01115
2021: HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01100
Total number of active participants reported on line 7a of the Form 55002021-07-01101
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01101

Form 5500 Responses for HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN

2022: HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Submission has been amendedNo
2022-07-01This submission is the final filingNo
2022-07-01This return/report is a short plan year return/report (less than 12 months)No
2022-07-01Plan is a collectively bargained planNo
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: HUMBOLDT STATE UNIVERSITY SPONSORED PROGRAMS FOUNDATION WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01First time form 5500 has been submittedYes
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number151786
Policy instance 1
Insurance contract or identification number151786
Number of Individuals Covered115
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $119,537
Total amount of fees paid to insurance companyUSD $49,764
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
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 $2,687,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $119,537
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number151786
Policy instance 1
Insurance contract or identification number151786
Number of Individuals Covered101
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $97,382
Total amount of fees paid to insurance companyUSD $40,277
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
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 $2,164,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $97,382
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3

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