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NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan NameNFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN
Plan identification number 511

NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Other welfare benefit cover

401k Sponsoring company profile

RAIDERS FOOTBALL CLUB, LLC has sponsored the creation of one or more 401k plans.

Company Name:RAIDERS FOOTBALL CLUB, LLC
Employer identification number (EIN):824689128
NAIC Classification:711210
NAIC Description: Spectator Sports

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5112022-04-01
5112021-04-01
5112020-04-01
5112019-04-01

Plan Statistics for NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN

Measure Date Value
2022: NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01284
Total number of active participants reported on line 7a of the Form 55002022-04-01311
Number of retired or separated participants receiving benefits2022-04-0123
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01334
2021: NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01286
Total number of active participants reported on line 7a of the Form 55002021-04-01269
Number of retired or separated participants receiving benefits2021-04-0120
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01289
2020: NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01274
Total number of active participants reported on line 7a of the Form 55002020-04-01260
Number of retired or separated participants receiving benefits2020-04-0118
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-01278
2019: NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01236
Total number of active participants reported on line 7a of the Form 55002019-04-01252
Number of retired or separated participants receiving benefits2019-04-0120
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01272

Financial Data on NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN

Measure Date Value
2023 : NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets2023-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-03-31$214,888
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-03-31$736,939
Total income from all sources (including contributions)2023-03-31$6,312,662
Total loss/gain on sale of assets2023-03-31$0
Total of all expenses incurred2023-03-31$6,276,724
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-03-31$6,130,807
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-03-31$6,310,744
Value of total assets at end of year2023-03-31$342,274
Value of total assets at beginning of year2023-03-31$828,387
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-03-31$145,917
Total interest from all sources2023-03-31$1,918
Total dividends received (eg from common stock, registered investment company shares)2023-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-03-31No
Administrative expenses professional fees incurred2023-03-31$69,096
Was this plan covered by a fidelity bond2023-03-31Yes
Value of fidelity bond cover2023-03-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2023-03-31No
Contributions received from participants2023-03-31$477,264
Liabilities. Value of operating payables at end of year2023-03-31$214,888
Liabilities. Value of operating payables at beginning of year2023-03-31$736,939
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-03-31No
Value of net income/loss2023-03-31$35,938
Value of net assets at end of year (total assets less liabilities)2023-03-31$127,386
Value of net assets at beginning of year (total assets less liabilities)2023-03-31$91,448
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-03-31No
Were any leases to which the plan was party in default or uncollectible2023-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-03-31$127,386
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-03-31$91,448
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-03-31$1,918
Expenses. Payments to insurance carriers foe the provision of benefits2023-03-31$900,282
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-03-31Yes
Was there a failure to transmit to the plan any participant contributions2023-03-31No
Has the plan failed to provide any benefit when due under the plan2023-03-31No
Contributions received in cash from employer2023-03-31$5,833,480
Employer contributions (assets) at end of year2023-03-31$214,888
Employer contributions (assets) at beginning of year2023-03-31$736,939
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-03-31$5,230,525
Contract administrator fees2023-03-31$76,821
Did the plan have assets held for investment2023-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-03-31No
Opinion of an independent qualified public accountant for this plan2023-03-31Unqualified
Accountancy firm name2023-03-31ABRAMS FOSTER NOLE & WILLIAMS PA
Accountancy firm EIN2023-03-31521854049
2022 : NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-03-31$736,939
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-03-31$12,263
Total income from all sources (including contributions)2022-03-31$6,283,747
Total loss/gain on sale of assets2022-03-31$0
Total of all expenses incurred2022-03-31$6,212,889
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-03-31$6,074,652
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-03-31$6,283,726
Value of total assets at end of year2022-03-31$828,387
Value of total assets at beginning of year2022-03-31$32,853
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-03-31$138,237
Total interest from all sources2022-03-31$21
Total dividends received (eg from common stock, registered investment company shares)2022-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-03-31No
Administrative expenses professional fees incurred2022-03-31$65,728
Was this plan covered by a fidelity bond2022-03-31Yes
Value of fidelity bond cover2022-03-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2022-03-31No
Contributions received from participants2022-03-31$1,293,310
Liabilities. Value of operating payables at end of year2022-03-31$736,939
Liabilities. Value of operating payables at beginning of year2022-03-31$12,263
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-03-31No
Value of net income/loss2022-03-31$70,858
Value of net assets at end of year (total assets less liabilities)2022-03-31$91,448
Value of net assets at beginning of year (total assets less liabilities)2022-03-31$20,590
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-03-31No
Were any leases to which the plan was party in default or uncollectible2022-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-03-31$91,448
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-03-31$20,590
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-03-31$21
Expenses. Payments to insurance carriers foe the provision of benefits2022-03-31$734,852
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-03-31Yes
Was there a failure to transmit to the plan any participant contributions2022-03-31No
Has the plan failed to provide any benefit when due under the plan2022-03-31No
Contributions received in cash from employer2022-03-31$4,990,416
Employer contributions (assets) at end of year2022-03-31$736,939
Employer contributions (assets) at beginning of year2022-03-31$12,263
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-03-31$5,339,800
Contract administrator fees2022-03-31$72,509
Did the plan have assets held for investment2022-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-03-31No
Opinion of an independent qualified public accountant for this plan2022-03-31Unqualified
Accountancy firm name2022-03-31ABRAMS FOSTER NOLE & WILLIAMS PA
Accountancy firm EIN2022-03-31521854049
2021 : NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-03-31$12,263
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-03-31$968,502
Total income from all sources (including contributions)2021-03-31$7,312,914
Total loss/gain on sale of assets2021-03-31$0
Total of all expenses incurred2021-03-31$7,362,449
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-03-31$7,230,119
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-03-31$7,312,611
Value of total assets at end of year2021-03-31$32,853
Value of total assets at beginning of year2021-03-31$1,038,627
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-03-31$132,330
Total interest from all sources2021-03-31$303
Total dividends received (eg from common stock, registered investment company shares)2021-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-03-31No
Was this plan covered by a fidelity bond2021-03-31Yes
Value of fidelity bond cover2021-03-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2021-03-31No
Contributions received from participants2021-03-31$270,497
Administrative expenses (other) incurred2021-03-31$132,330
Liabilities. Value of operating payables at end of year2021-03-31$12,263
Liabilities. Value of operating payables at beginning of year2021-03-31$968,502
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-03-31No
Value of net income/loss2021-03-31$-49,535
Value of net assets at end of year (total assets less liabilities)2021-03-31$20,590
Value of net assets at beginning of year (total assets less liabilities)2021-03-31$70,125
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-03-31No
Were any leases to which the plan was party in default or uncollectible2021-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-03-31$20,590
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-03-31$483,459
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-03-31$303
Expenses. Payments to insurance carriers foe the provision of benefits2021-03-31$809,166
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-03-31Yes
Was there a failure to transmit to the plan any participant contributions2021-03-31No
Has the plan failed to provide any benefit when due under the plan2021-03-31No
Contributions received in cash from employer2021-03-31$7,042,114
Employer contributions (assets) at end of year2021-03-31$12,263
Employer contributions (assets) at beginning of year2021-03-31$555,168
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-03-31$6,420,953
Did the plan have assets held for investment2021-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-03-31No
Opinion of an independent qualified public accountant for this plan2021-03-31Unqualified
Accountancy firm name2021-03-31ABRAMS FOSTER NOLE & WILLIAMS PA
Accountancy firm EIN2021-03-31521854049
2020 : NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$968,502
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$0
Total income from all sources (including contributions)2020-03-31$4,822,223
Total loss/gain on sale of assets2020-03-31$0
Total of all expenses incurred2020-03-31$4,753,927
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-03-31$4,636,522
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-03-31$4,819,892
Value of total assets at end of year2020-03-31$1,038,627
Value of total assets at beginning of year2020-03-31$1,829
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-03-31$117,405
Total interest from all sources2020-03-31$2,331
Total dividends received (eg from common stock, registered investment company shares)2020-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-03-31No
Was this plan covered by a fidelity bond2020-03-31Yes
Value of fidelity bond cover2020-03-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2020-03-31No
Contributions received from participants2020-03-31$212,409
Administrative expenses (other) incurred2020-03-31$117,405
Liabilities. Value of operating payables at end of year2020-03-31$968,502
Liabilities. Value of operating payables at beginning of year2020-03-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Value of net income/loss2020-03-31$68,296
Value of net assets at end of year (total assets less liabilities)2020-03-31$70,125
Value of net assets at beginning of year (total assets less liabilities)2020-03-31$1,829
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-03-31No
Were any leases to which the plan was party in default or uncollectible2020-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-03-31$483,459
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-03-31$1,829
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-03-31$2,331
Expenses. Payments to insurance carriers foe the provision of benefits2020-03-31$555,961
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-03-31Yes
Was there a failure to transmit to the plan any participant contributions2020-03-31No
Has the plan failed to provide any benefit when due under the plan2020-03-31No
Contributions received in cash from employer2020-03-31$4,607,483
Employer contributions (assets) at end of year2020-03-31$555,168
Employer contributions (assets) at beginning of year2020-03-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-03-31$4,080,561
Did the plan have assets held for investment2020-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-03-31No
Opinion of an independent qualified public accountant for this plan2020-03-31Unqualified
Accountancy firm name2020-03-31ABRAMS FOSTER NOLE & WILLIAMS PA
Accountancy firm EIN2020-03-31521854049

Form 5500 Responses for NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN

2022: NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2022 form 5500 responses
2022-04-01Type of plan entityMulitple employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – TrustYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement - TrustYes
2021: NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2021 form 5500 responses
2021-04-01Type of plan entityMulitple employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – TrustYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement - TrustYes
2020: NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2020 form 5500 responses
2020-04-01Type of plan entityMulitple employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – TrustYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement - TrustYes
2019: NFL EMPLOYEE RECIPROCAL FLEXIBLE BENEFITS PLAN 2019 form 5500 responses
2019-04-01Type of plan entityMulitple employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – TrustYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3209364
Policy instance 1
Insurance contract or identification number3209364
Number of Individuals Covered781
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3209364
Policy instance 1
Insurance contract or identification number3209364
Number of Individuals Covered720
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $433,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3209364
Policy instance 1
Insurance contract or identification number3209364
Number of Individuals Covered659
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $399,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3209364
Policy instance 1
Insurance contract or identification number3209364
Number of Individuals Covered612
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $300,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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