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AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN 401k Plan overview

Plan NameAMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN
Plan identification number 520

AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Other welfare benefit cover

401k Sponsoring company profile

AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. has sponsored the creation of one or more 401k plans.

Company Name:AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I.
Employer identification number (EIN):390273710
NAIC Classification:524150

Additional information about AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I.

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 1995277

More information about AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5202022-01-01KARI GRASEE2023-10-03

Plan Statistics for AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN

401k plan membership statisitcs for AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN

Measure Date Value
2022: AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01273
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-01328
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01328

Form 5500 Responses for AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN

2022: AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I. GROUP RETIREE-ONLY HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01First time form 5500 has been submittedYes
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract numberS5921
Policy instance 1
Insurance contract or identification numberS5921
Number of Individuals Covered435
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
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 $519,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberSRSUP
Policy instance 2
Insurance contract or identification numberSRSUP
Number of Individuals Covered435
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
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 $451,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

Potentially related plans

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