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| Plan Name | BASIC LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CONNECT HOME HEALTH |
| Employer identification number (EIN): | 461284372 |
| NAIC Classification: | 621610 |
| NAIC Description: | Home Health Care Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-03-01 | EZRA KUENZI | 2023-05-10 | ||
| 501 | 2021-03-01 | EZRA KUENZI | 2022-08-24 |
| Measure | Date | Value |
|---|---|---|
| 2022: BASIC LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-03-01 | 190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 194 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
| Total of all active and inactive participants | 2022-03-01 | 194 |
| Number of employers contributing to the scheme | 2022-03-01 | 0 |
| 2021: BASIC LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-03-01 | 192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 190 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 190 |
| Number of employers contributing to the scheme | 2021-03-01 | 0 |
| 2022: BASIC LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT 2022 form 5500 responses | ||
|---|---|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: BASIC LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT 2021 form 5500 responses | ||
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | First time form 5500 has been submitted | Yes |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |||||||||||||||||||||||||||
| Policy contract number | VF026447 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |||||||||||||||||||||||||||
| Policy contract number | VF026447 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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