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AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan NameAMBU, INC. HEALTH AND WELFARE BENEFITS PLAN
Plan identification number 501

AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

AMBU INC. has sponsored the creation of one or more 401k plans.

Company Name:AMBU INC.
Employer identification number (EIN):061090672
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-02-01RANDY MILLER2024-10-16
5012022-02-01KEISA HARTRIDGE2023-08-03
5012021-02-01KEISA HARTRIDGE2022-09-19
5012020-02-01KEISA HARTRIDGE2021-08-19
5012020-02-01KEISA HARTRIDGE2021-08-19
5012019-02-01

Plan Statistics for AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2023: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year2023-02-01317
Total number of active participants reported on line 7a of the Form 55002023-02-01318
Number of retired or separated participants receiving benefits2023-02-010
Number of other retired or separated participants entitled to future benefits2023-02-010
Total of all active and inactive participants2023-02-01318
Number of employers contributing to the scheme2023-02-010
2022: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01229
Total number of active participants reported on line 7a of the Form 55002022-02-01282
Number of retired or separated participants receiving benefits2022-02-012
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01284
Number of employers contributing to the scheme2022-02-010
2021: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01229
Total number of active participants reported on line 7a of the Form 55002021-02-0191
Number of retired or separated participants receiving benefits2021-02-011
Number of other retired or separated participants entitled to future benefits2021-02-011
Total of all active and inactive participants2021-02-0193
Number of employers contributing to the scheme2021-02-010
2020: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01237
Total number of active participants reported on line 7a of the Form 55002020-02-01420
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01420
Number of employers contributing to the scheme2020-02-010
2019: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01173
Total number of active participants reported on line 7a of the Form 55002019-02-01237
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01237

Form 5500 Responses for AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN

2023: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-02-01Type of plan entitySingle employer plan
2023-02-01Plan funding arrangement – InsuranceYes
2023-02-01Plan benefit arrangement – InsuranceYes
2022: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes
2020: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: AMBU, INC. HEALTH AND WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Submission has been amendedNo
2019-02-01This submission is the final filingNo
2019-02-01This return/report is a short plan year return/report (less than 12 months)No
2019-02-01Plan is a collectively bargained planNo
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3334505
Policy instance 1
Insurance contract or identification number3334505
Number of Individuals Covered277
Insurance policy start date2023-02-01
Insurance policy end date2024-01-31
Total amount of commissions paid to insurance brokerUSD $25,674
Total amount of fees paid to insurance companyUSD $175
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,156,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM603062
Policy instance 2
Insurance contract or identification numberSGM603062
Number of Individuals Covered318
Insurance policy start date2023-02-01
Insurance policy end date2024-01-31
Total amount of commissions paid to insurance brokerUSD $43,737
Total amount of fees paid to insurance companyUSD $10,243
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $206,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3334505
Policy instance 1
Insurance contract or identification number3334505
Number of Individuals Covered282
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $28,053
Total amount of fees paid to insurance companyUSD $157,472
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,380,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM603062
Policy instance 2
Insurance contract or identification numberSGM603062
Number of Individuals Covered282
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $42,091
Total amount of fees paid to insurance companyUSD $9,832
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $340,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3334505
Policy instance 1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD603008
Policy instance 2
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3334505
Policy instance 1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD603008
Policy instance 2

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