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| Plan Name | AREA15 MEDICAL DENTAL VISION PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | AREA15 |
| Employer identification number (EIN): | 371867131 |
| NAIC Classification: | 713900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-10-01 | DAN PELSON | 2024-04-16 | ||
| 501 | 2021-10-01 | DAN PELSON | 2023-04-14 |
| Measure | Date | Value |
|---|---|---|
| 2022: AREA15 MEDICAL DENTAL VISION PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-10-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 154 |
| Number of retired or separated participants receiving benefits | 2022-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-10-01 | 0 |
| Total of all active and inactive participants | 2022-10-01 | 154 |
| Number of employers contributing to the scheme | 2022-10-01 | 0 |
| 2021: AREA15 MEDICAL DENTAL VISION PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-10-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 113 |
| Number of retired or separated participants receiving benefits | 2021-10-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 0 |
| Total of all active and inactive participants | 2021-10-01 | 115 |
| Number of employers contributing to the scheme | 2021-10-01 | 0 |
| 2022: AREA15 MEDICAL DENTAL VISION PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: AREA15 MEDICAL DENTAL VISION PLAN 2021 form 5500 responses | ||
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | First time form 5500 has been submitted | Yes |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 929253 |
| Policy instance | 1 |
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) | |
| Policy contract number | L03884 |
| Policy instance | 1 |
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 95473 ) | |
| Policy contract number | L03884 |
| Policy instance | 2 |
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