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HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameHAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN
Plan identification number 501

HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

HAYNES FAMILY OF PROGRAMS has sponsored the creation of one or more 401k plans.

Company Name:HAYNES FAMILY OF PROGRAMS
Employer identification number (EIN):951506150
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-05-01TIFFANY BURG2024-10-21
5012022-05-01TIFFANY BURG2023-09-28
5012021-05-01
5012021-05-01TIFFANY BURG
5012020-05-01
5012019-05-01
5012017-05-01TIFFANY BURG

Plan Statistics for HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN

401k plan membership statisitcs for HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN

Measure Date Value
2023: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year2023-05-01197
Total number of active participants reported on line 7a of the Form 55002023-05-01238
Number of retired or separated participants receiving benefits2023-05-010
Number of other retired or separated participants entitled to future benefits2023-05-010
Total of all active and inactive participants2023-05-01238
Number of employers contributing to the scheme2023-05-010
2022: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-05-01240
Total number of active participants reported on line 7a of the Form 55002022-05-01196
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-01196
Number of employers contributing to the scheme2022-05-010
2021: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-01240
Total number of active participants reported on line 7a of the Form 55002021-05-01236
Number of retired or separated participants receiving benefits2021-05-014
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-01240
2020: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-01358
Total number of active participants reported on line 7a of the Form 55002020-05-01229
Number of retired or separated participants receiving benefits2020-05-0111
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-01240
2019: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-01264
Total number of active participants reported on line 7a of the Form 55002019-05-01351
Number of retired or separated participants receiving benefits2019-05-017
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-01358
2017: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01234
Total number of active participants reported on line 7a of the Form 55002017-05-01245
Number of retired or separated participants receiving benefits2017-05-011
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-01246

Form 5500 Responses for HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN

2023: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-05-01Type of plan entitySingle employer plan
2023-05-01Plan funding arrangement – InsuranceYes
2023-05-01Plan funding arrangement – General assets of the sponsorYes
2023-05-01Plan benefit arrangement – InsuranceYes
2023-05-01Plan benefit arrangement – General assets of the sponsorYes
2022: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan funding arrangement – General assets of the sponsorYes
2022-05-01Plan benefit arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – General assets of the sponsorYes
2021: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)No
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan funding arrangement – General assets of the sponsorYes
2021-05-01Plan benefit arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – General assets of the sponsorYes
2020: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – InsuranceYes
2019: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – InsuranceYes
2017: HAYNES FAMILY OF PROGRAMS HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BCB2
Policy instance 2
Insurance contract or identification numberGLUG0BCB2
Number of Individuals Covered390
Insurance policy start date2023-05-01
Insurance policy end date2024-04-30
Total amount of commissions paid to insurance brokerUSD $9,754
Total amount of fees paid to insurance companyUSD $2,218
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $79,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number282926
Policy instance 1
Insurance contract or identification number282926
Number of Individuals Covered331
Insurance policy start date2023-05-01
Insurance policy end date2024-04-30
Total amount of commissions paid to insurance brokerUSD $12,752
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $128,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BCB2
Policy instance 2
Insurance contract or identification numberGLUG0BCB2
Number of Individuals Covered330
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $8,934
Total amount of fees paid to insurance companyUSD $2,385
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $73,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number282926
Policy instance 1
Insurance contract or identification number282926
Number of Individuals Covered315
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $16,962
Total amount of fees paid to insurance companyUSD $875
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BCB2
Policy instance 1
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number282926
Policy instance 2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BCB2
Policy instance 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BCB2
Policy instance 4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BCB2
Policy instance 5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BCB2
Policy instance 4
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number282926
Policy instance 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BCB2
Policy instance 2
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number282926
Policy instance 1
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 61557 )
Policy contract numberW0063843
Policy instance 8
BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 )
Policy contract numberW0063843
Policy instance 7
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BCB2
Policy instance 1
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberS0997
Policy instance 2
PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )
Policy contract number14884
Policy instance 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1016915/1016974
Policy instance 4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BCB2
Policy instance 5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BCB2
Policy instance 6
PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )
Policy contract number14884
Policy instance 2
BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 )
Policy contract numberW0063843
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number420602
Policy instance 4
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 61557 )
Policy contract numberW0063843
Policy instance 5
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberS0997
Policy instance 6
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number420602
Policy instance 7
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12284574
Policy instance 1

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