401k Plan data: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN plan

PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 401k Plan overview

Plan Name	PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN
Plan identification number	521

PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

PENN MUTUAL LIFE INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: PENN MUTUAL LIFE INSURANCE COMPANY

Employer identification number (EIN): 230952300

NAIC Classification: 524140

Additional information about PENN MUTUAL LIFE INSURANCE COMPANY

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0000677

More information about PENN MUTUAL LIFE INSURANCE COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
521 2023-01-01 MAGGIE REIM 2024-09-05 DAVID RASZEJA 2024-09-05
521 2022-01-01 MAGGIE REIM 2023-09-11 DAVID RASZEJA 2023-09-12
521 2021-01-01 MAGGIE REIM 2022-10-10 DAVID RASZEJA 2022-10-10
521 2020-01-01 JENNIFER KEASHON 2021-10-12 DAVID RASZEJA 2021-10-12
521 2019-01-01 JENNIFER KEASHON 2020-10-13 DAVID RASZEJA 2020-10-13
521 2018-01-01 JENNIFER KEASHON 2019-10-14 SUSAN DEAKINS 2019-10-14
521 2017-01-01
521 2016-01-01
521 2015-01-01
521 2014-01-01
521 2013-01-01
521 2012-01-01 PAUL JEFFERS DAVID OMALLEY 2013-09-30
521 2011-01-01 TIMOTHY DEMETRES DAVID OMALLEY 2012-10-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
521	2023-01-01	MAGGIE REIM	2024-09-05	DAVID RASZEJA	2024-09-05
521	2022-01-01	MAGGIE REIM	2023-09-11	DAVID RASZEJA	2023-09-12
521	2021-01-01	MAGGIE REIM	2022-10-10	DAVID RASZEJA	2022-10-10
521	2020-01-01	JENNIFER KEASHON	2021-10-12	DAVID RASZEJA	2021-10-12
521	2019-01-01	JENNIFER KEASHON	2020-10-13	DAVID RASZEJA	2020-10-13
521	2018-01-01	JENNIFER KEASHON	2019-10-14	SUSAN DEAKINS	2019-10-14
521	2017-01-01
521	2016-01-01
521	2015-01-01
521	2014-01-01
521	2013-01-01
521	2012-01-01	PAUL JEFFERS		DAVID OMALLEY	2013-09-30
521	2011-01-01	TIMOTHY DEMETRES		DAVID OMALLEY	2012-10-09

Form 5500 Responses for PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN

2023: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: PENN MUTUAL LIFE INS CO RETIREE GROUP HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 )

Policy contract number

AWF50281001

Policy instance

Insurance contract or identification number	AWF50281001
Number of Individuals Covered	210
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $56,947
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $541,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0930839H0007A

Policy instance

Insurance contract or identification number	MZ0930839H0007A
Number of Individuals Covered	211
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $106,811
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $487,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 )

Policy contract number

AWF50281001

Policy instance

Insurance contract or identification number	AWF50281001
Number of Individuals Covered	228
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $61,875
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $570,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0930839H0007A

Policy instance

Insurance contract or identification number	MZ0930839H0007A
Number of Individuals Covered	228
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $113,285
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $516,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 )

Policy contract number

AWF50281001

Policy instance

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0930839H0007A

Policy instance

ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 )

Policy contract number

AWF50281001

Policy instance

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0930839H0007A

Policy instance

ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 )

Policy contract number

AWF50281001

Policy instance

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0930839H0007A

Policy instance

STONEBRIDGE LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 65021 )

Policy contract number

S9579044

Policy instance

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0930839H0007A

Policy instance

STONEBRIDGE LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 65021 )

Policy contract number

S9579044

Policy instance

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0930839H0007A

Policy instance

Potentially related plans

PENN MUTUAL LIFE A SIMPLIFIED EMPLOYEE PENSION PLAN [EIN = 420989781]

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Company Name:	PENN MUTUAL LIFE INSURANCE COMPANY
Employer identification number (EIN):	230952300
NAIC Classification:	524140

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0000677