401k Plan data: MIDSTATE ARC HEALTH & WELFARE PLAN plan

MIDSTATE ARC HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	MIDSTATE ARC HEALTH & WELFARE PLAN
Plan identification number	501

MIDSTATE ARC HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MIDSTATE ARC, INC. has sponsored the creation of one or more 401k plans.

Company Name: MIDSTATE ARC, INC.

Employer identification number (EIN): 060756834

NAIC Classification: 531210
NAIC Description: Offices of Real Estate Agents and Brokers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDSTATE ARC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-07-01 MARITZA DELL 2025-01-02
501 2022-07-01 PAM FIELDS 2024-01-31

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-07-01	MARITZA DELL	2025-01-02
501	2022-07-01	PAM FIELDS	2024-01-31

Form 5500 Responses for MIDSTATE ARC HEALTH & WELFARE PLAN

2023: MIDSTATE ARC HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2022: MIDSTATE ARC HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	First time form 5500 has been submitted	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 )

Policy contract number

1150134

Policy instance

Insurance contract or identification number	1150134
Number of Individuals Covered	100
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $44,653
Total amount of fees paid to insurance company	USD $6,403
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,116,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

801335

Policy instance

Insurance contract or identification number	801335
Number of Individuals Covered	111
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $2,856
Total amount of fees paid to insurance company	USD $886
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,234
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

897997G

Policy instance

Insurance contract or identification number	897997G
Number of Individuals Covered	178
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $520
Total amount of fees paid to insurance company	USD $112
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0924629

Policy instance

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

801335

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

897997G

Policy instance

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Company Name:	MIDSTATE ARC, INC.
Employer identification number (EIN):	060756834
NAIC Classification:	531210
NAIC Description:	Offices of Real Estate Agents and Brokers