401k Plan data: CUMBERLAND MUTUAL FIRE INSURANCE CO. HEALTH AND WELFARE BENEFIT PLAN plan

CUMBERLAND MUTUAL FIRE INSURANCE CO. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CUMBERLAND MUTUAL FIRE INSURANCE CO. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	506

CUMBERLAND MUTUAL FIRE INSURANCE CO. HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare 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

401k Sponsoring company profile

CUMBERLAND MUTUAL FIRE INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: CUMBERLAND MUTUAL FIRE INSURANCE COMPANY

Employer identification number (EIN): 210434400

NAIC Classification: 524150

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CUMBERLAND MUTUAL FIRE INSURANCE CO. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2023-01-01 NEAL PIERCE 2024-06-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
506	2023-01-01	NEAL PIERCE	2024-06-12

Form 5500 Responses for CUMBERLAND MUTUAL FIRE INSURANCE CO. HEALTH AND WELFARE BENEFIT PLAN

2023: CUMBERLAND MUTUAL FIRE INSURANCE CO. HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

9532

Policy instance

Insurance contract or identification number	9532
Number of Individuals Covered	287
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $5,205
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

3881

Policy instance

Insurance contract or identification number	3881
Number of Individuals Covered	125
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $893
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

86831-050

Policy instance

Insurance contract or identification number	86831-050
Number of Individuals Covered	133
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $58,507
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $2,405,234
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 number

SGM608237

Policy instance

Insurance contract or identification number	SGM608237
Number of Individuals Covered	140
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $10,284
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $171,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	CUMBERLAND MUTUAL FIRE INSURANCE COMPANY
Employer identification number (EIN):	210434400
NAIC Classification:	524150