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| Plan Name | MIDSTATE ARC HEALTH & WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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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 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-07-01 | PAM FIELDS | 2024-01-31 |
| Measure | Date | Value |
|---|---|---|
| 2022: MIDSTATE ARC HEALTH & WELFARE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-07-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 166 |
| Number of retired or separated participants receiving benefits | 2022-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
| Total of all active and inactive participants | 2022-07-01 | 166 |
| Number of employers contributing to the scheme | 2022-07-01 | 0 |
| 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 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||
| Policy contract number | 0924629 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
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| ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 ) | |||||||||||||||||||||||||||||
| Policy contract number | 801335 | ||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |||||||||||||||||||||||||||||
| Policy contract number | 897997G | ||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||
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