401k Plan data: MEDICAL/DENTAL PLAN plan

MEDICAL/DENTAL PLAN 401k Plan overview

Plan Name	MEDICAL/DENTAL PLAN
Plan identification number	502

MEDICAL/DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	SELECT distinct(Description) AS Description FROM 401k_benefit_codes LEFT JOIN 401k_benefit_code_description ON BenefitCode=Code COLLATE utf8_unicode_ci WHERE EIN='362722198' AND PlanID='502'

401k Sponsoring company profile

BENEDICTINE UNIVERSITY has sponsored the creation of one or more 401k plans.

Company Name: BENEDICTINE UNIVERSITY

Employer identification number (EIN): 362722198

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL/DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01 KELLY L. ZAPP 2024-07-24
502 2022-01-01 KELLY ZAPP 2023-07-19
502 2021-01-01 KELLY ZAPP 2022-07-11
502 2020-01-01 KELLY ZAPP 2021-07-14
502 2019-01-01 KELLY L. ZAPP 2020-07-28
502 2018-01-01
502 2017-01-01 BETSY RHINESMITH
502 2016-01-01 BETSY RHINESMITH
502 2015-01-01 BETSY RHINESMITH
502 2014-01-01 BETSY RHINESMITH ALLAN GOZUM 2015-07-28
502 2013-01-01 BETSY RHINESMITH ALLAN GOZUM 2014-10-13
502 2012-01-01 ALLAN GOZUM
502 2011-01-01 ALLAN GOZUM
502 2009-01-01 ALLAN GOZUM

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2023-01-01	KELLY L. ZAPP	2024-07-24
502	2022-01-01	KELLY ZAPP	2023-07-19
502	2021-01-01	KELLY ZAPP	2022-07-11
502	2020-01-01	KELLY ZAPP	2021-07-14
502	2019-01-01	KELLY L. ZAPP	2020-07-28
502	2018-01-01
502	2017-01-01	BETSY RHINESMITH
502	2016-01-01	BETSY RHINESMITH
502	2015-01-01	BETSY RHINESMITH
502	2014-01-01	BETSY RHINESMITH		ALLAN GOZUM	2015-07-28
502	2013-01-01	BETSY RHINESMITH		ALLAN GOZUM	2014-10-13
502	2012-01-01	ALLAN GOZUM
502	2011-01-01	ALLAN GOZUM
502	2009-01-01	ALLAN GOZUM

Insurance Providers Used on plan

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

8429

Policy instance

Insurance contract or identification number	8429
Number of Individuals Covered	259
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $11,055
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

1099

Policy instance

Insurance contract or identification number	1099
Number of Individuals Covered	545
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $90,565
Total amount of fees paid to insurance company	USD $3,266
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,535,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

8429

Policy instance

Insurance contract or identification number	8429
Number of Individuals Covered	298
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $12,740
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $254,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

1099

Policy instance

Insurance contract or identification number	1099
Number of Individuals Covered	600
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $94,988
Total amount of fees paid to insurance company	USD $3,845
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,742,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

8429

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

1099

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

1099

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

8429

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

8429

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

1099

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

8429

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B01099

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B/H/P01099

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

08429

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

08429

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B/H/P01099

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

08429

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B/H/P01099

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

08429

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B/H/P01099

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B/H/P01099

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

08429

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B/H/P01099

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

08429

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

08429

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B/H/P01099

Policy instance

Potentially related plans

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Company Name:	BENEDICTINE UNIVERSITY
Employer identification number (EIN):	362722198
NAIC Classification:	611000