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| Plan Name | MEDICAL PPO |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | KLASKO IMMIGRATION LAW PARTNERS, LLP |
| Employer identification number (EIN): | 200436420 |
| NAIC Classification: | 541110 |
| NAIC Description: | Offices of Lawyers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-01-01 | ANGELA DEVINE | 2023-05-24 |
| Measure | Date | Value |
|---|---|---|
| 2022: MEDICAL PPO 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 110 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 110 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2022: MEDICAL PPO 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | First time form 5500 has been submitted | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 1004197 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | A15077-000 | ||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||
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| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 10883 | ||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||
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