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CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 401k Plan overview

Plan NameCAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN
Plan identification number 501

CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

EMMA, INC. has sponsored the creation of one or more 401k plans.

Company Name:EMMA, INC.
Employer identification number (EIN):621870397
NAIC Classification:541519
NAIC Description:Other Computer Related Services

Additional information about EMMA, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 1998-01-07
Company Identification Number: 601844885
Legal Registered Office Address: 3026 BEACON AVE S # 101

SEATTLE
United States of America (USA)
98144

More information about EMMA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01SUSAN ADAMS2023-12-20
5012018-11-01
5012017-11-01JESSICA GROSCH2019-05-20
5012016-11-01JESSICA GROSCH JESSICA GROSCH2018-05-22
5012015-11-01JESSICA GROSCH JESSICA GROSCH2017-05-25
5012014-11-01ROBERT SPESSARD ROBERT SPESSARD2016-06-08

Plan Statistics for CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN

401k plan membership statisitcs for CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN

Measure Date Value
2022: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01385
Total number of active participants reported on line 7a of the Form 55002022-01-01368
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01370
Number of employers contributing to the scheme2022-01-010
2018: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01172
Total number of active participants reported on line 7a of the Form 55002018-11-010
Number of retired or separated participants receiving benefits2018-11-010
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-010
Number of employers contributing to the scheme2018-11-010
2017: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01172
Total number of active participants reported on line 7a of the Form 55002017-11-01172
Number of retired or separated participants receiving benefits2017-11-010
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-01172
Number of employers contributing to the scheme2017-11-010
2016: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01150
Total number of active participants reported on line 7a of the Form 55002016-11-01170
Number of retired or separated participants receiving benefits2016-11-012
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-11-010
Total participants2016-11-01172
2015: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01138
Total number of active participants reported on line 7a of the Form 55002015-11-01149
Number of retired or separated participants receiving benefits2015-11-012
Number of other retired or separated participants entitled to future benefits2015-11-010
Total of all active and inactive participants2015-11-01151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-11-010
Total participants2015-11-01151
2014: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01110
Total number of active participants reported on line 7a of the Form 55002014-11-01143
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-010
Total of all active and inactive participants2014-11-01143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-11-010
Total participants2014-11-01143
Number of participants with account balances2014-11-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-11-010

Form 5500 Responses for CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN

2022: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
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
2018: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01This submission is the final filingYes
2018-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – InsuranceYes
2017: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – InsuranceYes
2016: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01First time form 5500 has been submittedYes
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes
2015: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01First time form 5500 has been submittedYes
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – InsuranceYes
2014: CAMPAIGN MONITOR USA INC. HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01First time form 5500 has been submittedYes
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3344736
Policy instance 1
Insurance contract or identification number3344736
Number of Individuals Covered697
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,492
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,492
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number7688
Policy instance 2
Insurance contract or identification number7688
Number of Individuals Covered667
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $26,700
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,700
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BM7P
Policy instance 3
Insurance contract or identification numberGLUG0BM7P
Number of Individuals Covered368
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $22,104
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM,ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $147,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,104
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number120337
Policy instance 1
Insurance contract or identification number120337
Number of Individuals Covered397
Insurance policy start date2018-11-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $9,496
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,407
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-04361500001
Policy instance 2
Insurance contract or identification number010-04361500001
Number of Individuals Covered167
Insurance policy start date2018-11-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,940
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,940
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number120337
Policy instance 1
Insurance contract or identification number120337
Number of Individuals Covered404
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $42,125
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number00
Policy instance 2
Insurance contract or identification number00
Number of Individuals Covered354
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $11,084
Total amount of fees paid to insurance companyUSD $732
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $110,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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