401k Plan data: PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB plan

PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB 401k Plan overview

Plan Name	PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB
Plan identification number	504

PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

PEABODY ESSEX MUSEUM has sponsored the creation of one or more 401k plans.

Company Name: PEABODY ESSEX MUSEUM

Employer identification number (EIN): 043157815

NAIC Classification: 712100
NAIC Description: Museums, Historical Sites, and Similar Institutions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2008-01-01 ALISON ROSS 2022-07-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2008-01-01	ALISON ROSS	2022-07-01

Plan Statistics for PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB

401k plan membership statisitcs for PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB

Measure Date Value
2008: PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB 2008 401k membership
Total participants, beginning-of-year 2008-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 89
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Total of all active and inactive participants 2008-01-01 89
Number of employers contributing to the scheme 2008-01-01 0

Measure	Date	Value
2008: PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB 2008 401k membership
Total participants, beginning-of-year	2008-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	89
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Total of all active and inactive participants	2008-01-01	89
Number of employers contributing to the scheme	2008-01-01	0

Form 5500 Responses for PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB

2008: PEABODY ESSEX MUSEUM HEALTH INSURANCE HMOB 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	Yes
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	89
Insurance policy start date	2008-05-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $25,189
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $831,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,189
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

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Company Name:	PEABODY ESSEX MUSEUM
Employer identification number (EIN):	043157815
NAIC Classification:	712100
NAIC Description:	Museums, Historical Sites, and Similar Institutions