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| Plan Name | UNITED COMMUNITY ACTION PARTNERSHIP MEDICAL RIDER |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | UNITED COMMUNITY ACTION PARTNERSHIP |
| Employer identification number (EIN): | 410904860 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2022-01-01 | CONNIE KAMSTRA | 2023-07-26 |
| Measure | Date | Value |
|---|---|---|
| 2022: UNITED COMMUNITY ACTION PARTNERSHIP MEDICAL RIDER 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 135 |
| 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 | 135 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2022: UNITED COMMUNITY ACTION PARTNERSHIP MEDICAL RIDER 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 benefit arrangement – Insurance | Yes |
| EBMS RE-BENCHMARK INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 41394 ) | |||||||||||||||||||
| Policy contract number | 00 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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