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REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES 401k Plan overview

Plan NameREFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES
Plan identification number 502

REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

REFORMED CHURCH IN AMERICA has sponsored the creation of one or more 401k plans.

Company Name:REFORMED CHURCH IN AMERICA
Employer identification number (EIN):135562285
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022013-10-01JILLISA TEITSMA
5022012-10-01RHONDA LIGHTCAP
5022011-10-01RHONDA LIGHTCAP

Plan Statistics for REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES

401k plan membership statisitcs for REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES

Measure Date Value
2013: REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES 2013 401k membership
Total participants, beginning-of-year2013-10-01261
Total number of active participants reported on line 7a of the Form 55002013-10-010
Total of all active and inactive participants2013-10-010
2012: REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES 2012 401k membership
Total participants, beginning-of-year2012-10-01282
Number of retired or separated participants receiving benefits2012-10-01261
Total of all active and inactive participants2012-10-01261
2011: REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES 2011 401k membership
Total participants, beginning-of-year2011-10-01296
Number of retired or separated participants receiving benefits2011-10-01282
Total of all active and inactive participants2011-10-01282

Form 5500 Responses for REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES

2013: REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01This submission is the final filingYes
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN FOR RETIREES 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number710172
Policy instance 1
Insurance contract or identification number710172
Number of Individuals Covered13
Insurance policy start date2013-10-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $399
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $2,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $399
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number710172
Policy instance 1
Insurance contract or identification number710172
Number of Individuals Covered10
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $612
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $7,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $612
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number710172
Policy instance 1
Insurance contract or identification number710172
Number of Individuals Covered9
Insurance policy start date2012-01-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $612
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $6,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberMSL 3702641
Policy instance 2
Insurance contract or identification numberMSL 3702641
Number of Individuals Covered0
Insurance policy start date2011-10-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $412
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $4,122
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 number710172
Policy instance 1
Insurance contract or identification number710172
Number of Individuals Covered0
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $335
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $3,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberMSL 3702641
Policy instance 2
Insurance contract or identification numberMSL 3702641
Number of Individuals Covered32
Insurance policy start date2011-01-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $1,155
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $11,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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