| Plan Name | EMPLOYEE HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | NATIONAL COLLEGIATE INVENTORS & INNOVATORS ALLIANCE, INC. |
| Employer identification number (EIN): | 421727335 |
| NAIC Classification: | 611000 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-07-01 | CHRIS DESROSIERS | 2024-12-20 | ||
| 501 | 2022-07-01 | ||||
| 501 | 2022-07-01 | CHRISTOPHER DESROSIERS |
| 2023: EMPLOYEE HEALTH AND WELFARE PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-07-01 | Type of plan entity | Single employer plan |
| 2023-07-01 | Plan funding arrangement – Insurance | Yes |
| 2023-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: EMPLOYEE HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | First time form 5500 has been submitted | Yes |
| 2022-07-01 | Submission has been amended | No |
| 2022-07-01 | This submission is the final filing | No |
| 2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-07-01 | Plan is a collectively bargained plan | No |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) | |||||||||||||||||||||||||
| Policy contract number | 4955873 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |||||||||||||||||||||||||
| Policy contract number | 218558 | ||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||
| |||||||||||||||||||||||||
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |||||||||||||||||||||||||
| Policy contract number | 218558 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) | |||||||||||||||||||||||||
| Policy contract number | 4955873 | ||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||