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| Plan Name | LUTHERAN SOCIAL SERVICES OF MICHIGAN HEALTHCARE BENEFIT PLAN |
| Plan identification number | 511 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | LUTHERAN SOCIAL SERVICES OF MICHIGAN |
| Employer identification number (EIN): | 311360553 |
| NAIC Classification: | 813000 |
| NAIC Description: | Religious, Grantmaking, Civic, Professional, and Similar Organizations |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 511 | 2014-10-01 | KENNETH ULRICH |
| Measure | Date | Value |
|---|---|---|
| 2014: LUTHERAN SOCIAL SERVICES OF MICHIGAN HEALTHCARE BENEFIT PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-10-01 | 1,092 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 1,162 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 1 |
| Total of all active and inactive participants | 2014-10-01 | 1,163 |
| Total participants | 2014-10-01 | 1,163 |
| 2014: LUTHERAN SOCIAL SERVICES OF MICHIGAN HEALTHCARE BENEFIT PLAN 2014 form 5500 responses | ||
|---|---|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) | |
| Policy contract number | 773727 S003 |
| Policy instance | 1 |
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) | |
| Policy contract number | 773727 S003 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 0001250 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30021323 |
| Policy instance | 4 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 674505G |
| Policy instance | 5 |
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