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COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 401k Plan overview

Plan NameCOMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION
Plan identification number 501

COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 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

COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC.
Employer identification number (EIN):731019247
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01KAREN KIELY2024-07-02
5012022-01-01KAREN L KIELY2023-07-17
5012021-01-01LEX ANDERSON2022-05-26
5012020-01-01LEX ANDERSON2021-07-08
5012019-01-01KAREN KIELY2020-07-22
5012018-01-01
5012017-01-01
5012016-01-01KAREN L. KIELY
5012015-01-01KAREN KIELY
5012014-01-01JOANNE LUCAS
5012013-01-01JOANNE LUCAS JOANNE LUCAS2014-07-30
5012012-01-01JOANNE LUCAS JOANNE LUCAS2013-07-31
5012011-01-01JOANNE LUCAS
5012009-04-01DEDE CHERRY

Form 5500 Responses for COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION

2023: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
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
2021: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: COMMUNITY ACTION PROJECT OF TULSA COUNTY, INC. WELFARE BENEFITS PLAN AND SUMMARY PLAN DESCRIPTION 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MODERN HEALTH ARIZONA P.L.L.C (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUNKNOWN
Policy instance 4
Insurance contract or identification numberUNKNOWN
Number of Individuals Covered583
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036985
Policy instance 3
Insurance contract or identification number30036985
Number of Individuals Covered465
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $2,953
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1454
Policy instance 2
Insurance contract or identification number1454
Number of Individuals Covered504
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $14,696
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
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number101630200
Policy instance 1
Insurance contract or identification number101630200
Number of Individuals Covered583
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $41,948
Total amount of fees paid to insurance companyUSD $19,235
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $319,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number101630200
Policy instance 1
Insurance contract or identification number101630200
Number of Individuals Covered606
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $53,881
Total amount of fees paid to insurance companyUSD $17,530
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $496,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberCOMMUNITY ACT
Policy instance 2
Insurance contract or identification numberCOMMUNITY ACT
Number of Individuals Covered596
Insurance policy start date2022-01-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $4,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1454
Policy instance 3
Insurance contract or identification number1454
Number of Individuals Covered491
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $13,548
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
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036985
Policy instance 4
Insurance contract or identification number30036985
Number of Individuals Covered452
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,207
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MODERN HEALTH ARIZONA P.L.L.C (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUNKNOWN
Policy instance 5
Insurance contract or identification numberUNKNOWN
Number of Individuals Covered606
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number101630200
Policy instance 1
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberCOMMUNITY ACT
Policy instance 2
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1454
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036985
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036985
Policy instance 4
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1454
Policy instance 3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberCOMMUNITY ACT
Policy instance 2
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number101630200
Policy instance 1
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number101630200
Policy instance 1
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberCOMMUNITY ACT
Policy instance 2
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1454
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036985
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036985
Policy instance 4
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1454
Policy instance 3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberCOMMUNITY ACT
Policy instance 2
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016302-00
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036985
Policy instance 4
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number0001454
Policy instance 3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberCOMMUNITY ACT
Policy instance 2
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016302-00
Policy instance 1
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract number00
Policy instance 1
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1454
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number30036985
Policy instance 3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016302-00
Policy instance 4
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number142707
Policy instance 5
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016302-00
Policy instance 6
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberC01207
Policy instance 1
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1454
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number30036985
Policy instance 3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016302-00
Policy instance 4
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016302-00
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number30036985
Policy instance 3
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number600109
Policy instance 2
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberC01207
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHXJ
Policy instance 2
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number600109
Policy instance 3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberC01207
Policy instance 4
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number600109
Policy instance 5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHXJ
Policy instance 6
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHXJ
Policy instance 7
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHXJ
Policy instance 1
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 )
Policy contract numberHD0513
Policy instance 1

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