| Plan Name | ON-SITE HEALTH & SAFETY |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | IOSM |
| Employer identification number (EIN): | 711003664 |
| NAIC Classification: | 541990 |
| NAIC Description: | All Other Professional, Scientific, and Technical Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-11-01 | ZULEMA GARCIA | |||
| 501 | 2022-11-01 | ZULEMA GARCIA | 2024-03-25 |
| Measure | Date | Value |
|---|---|---|
| 2022: ON-SITE HEALTH & SAFETY 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-11-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-11-01 | 158 |
| Total of all active and inactive participants | 2022-11-01 | 158 |
| 2022: ON-SITE HEALTH & SAFETY 2022 form 5500 responses | ||
|---|---|---|
| 2022-11-01 | Type of plan entity | Single employer plan |
| 2022-11-01 | First time form 5500 has been submitted | Yes |
| 2022-11-01 | Submission has been amended | No |
| 2022-11-01 | This submission is the final filing | No |
| 2022-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-11-01 | Plan is a collectively bargained plan | No |
| 2022-11-01 | Plan funding arrangement – Insurance | Yes |
| 2022-11-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | J75862 |
| Policy instance | 1 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00028526 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 348781 |
| Policy instance | 3 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 72165 |
| Policy instance | 4 |