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| Plan Name | CAFETERIA PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | COLLINSON, INC. |
| Employer identification number (EIN): | 463194709 |
| NAIC Classification: | 721199 |
| NAIC Description: | All Other Traveler Accommodation |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-10-01 |
| Measure | Date | Value |
|---|---|---|
| 2019: CAFETERIA PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-10-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 115 |
| Total of all active and inactive participants | 2019-10-01 | 115 |
| Total participants | 2019-10-01 | 115 |
| 2019: CAFETERIA PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Submission has been amended | No |
| 2019-10-01 | This submission is the final filing | No |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-10-01 | Plan is a collectively bargained plan | No |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 114912 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5927607 |
| Policy instance | 2 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30057739 |
| Policy instance | 3 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 00627106 |
| Policy instance | 4 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |
| Policy contract number | G000BFD9 |
| Policy instance | 5 |