| Plan Name | NORTH CENTRAL INTERNATIONAL HEALTH AND WELFARE PLAN |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | NORTH CENTRAL INTERNATIONAL LLC |
| Employer identification number (EIN): | 841945153 |
| NAIC Classification: | 423100 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2022-03-01 | DANIEL GROTHE | 2023-10-12 |
| 2022: NORTH CENTRAL INTERNATIONAL HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | First time form 5500 has been submitted | Yes |
| 2022-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||
| Policy contract number | 609409 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||
| Policy contract number | 00 | ||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||
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