3 PHASE ELEVATOR CORP. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan 3 PHASE ELEVATOR HEALTH & WELFARE PLAN
| 2023: 3 PHASE ELEVATOR HEALTH & WELFARE PLAN 2023 form 5500 responses |
|---|
| 2023-08-01 | Type of plan entity | Single employer plan |
| 2023-08-01 | Plan funding arrangement – Insurance | Yes |
| 2023-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: 3 PHASE ELEVATOR HEALTH & WELFARE PLAN 2022 form 5500 responses |
|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | First time form 5500 has been submitted | Yes |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4960438 |
| Policy instance | 1 |
| Insurance contract or identification number | 4960438 | | Number of Individuals Covered | 332 | | Insurance policy start date | 2023-08-01 | | Insurance policy end date | 2024-07-31 | | Total amount of commissions paid to insurance broker | USD $49,044 | | Total amount of fees paid to insurance company | USD $15,840 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | 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 number | 40149726 |
| Policy instance | 2 |
| Insurance contract or identification number | 40149726 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2023-08-01 | | Insurance policy end date | 2024-07-31 | | Total amount of commissions paid to insurance broker | USD $1,119 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 898007G |
| Policy instance | 3 |
| Insurance contract or identification number | 898007G | | Number of Individuals Covered | 202 | | Insurance policy start date | 2023-08-01 | | Insurance policy end date | 2024-07-31 | | Total amount of commissions paid to insurance broker | USD $8,207 | | Total amount of fees paid to insurance company | USD $13,834 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $181,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 357537 |
| Policy instance | 4 |
| Insurance contract or identification number | 357537 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $8,296 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $224,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4960438 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 40149726 |
| Policy instance | 2 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 898007G |
| Policy instance | 3 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 357537 |
| Policy instance | 4 |
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