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| Plan Name | AMERISURE MUTUAL INSURANCE COMPANY GRANDFATHERED LIFE INSURANCE PLAN |
| Plan identification number | 506 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | AMERISURE MUTUAL INSURANCE COMPANY 401K SAVINGS PLAN |
| Employer identification number (EIN): | 380829210 |
| NAIC Classification: | 524150 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 506 | 2022-01-01 | ||||
| 506 | 2021-01-01 | ||||
| 506 | 2020-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2022: AMERISURE MUTUAL INSURANCE COMPANY GRANDFATHERED LIFE INSURANCE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 295 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 279 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 280 |
| Total participants | 2022-01-01 | 280 |
| 2021: AMERISURE MUTUAL INSURANCE COMPANY GRANDFATHERED LIFE INSURANCE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 316 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 295 |
| Total of all active and inactive participants | 2021-01-01 | 295 |
| Total participants | 2021-01-01 | 295 |
| 2020: AMERISURE MUTUAL INSURANCE COMPANY GRANDFATHERED LIFE INSURANCE PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 346 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 3 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 313 |
| Total of all active and inactive participants | 2020-01-01 | 316 |
| Total participants | 2020-01-01 | 316 |
| 2022: AMERISURE MUTUAL INSURANCE COMPANY GRANDFATHERED LIFE INSURANCE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: AMERISURE MUTUAL INSURANCE COMPANY GRANDFATHERED LIFE INSURANCE PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: AMERISURE MUTUAL INSURANCE COMPANY GRANDFATHERED LIFE INSURANCE PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | First time form 5500 has been submitted | Yes |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0184851 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0184851 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0184851 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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