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USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 401k Plan overview

Plan NameUSUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN
Plan identification number 501

USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

USUI INTERNATIONAL CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:USUI INTERNATIONAL CORPORATION
Employer identification number (EIN):382726508
NAIC Classification:336300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-08-01TIM SIRCY2025-01-23
5012022-08-01TIM SIRCY2024-05-23
5012021-08-01TIM SIRCY2023-02-28
5012020-08-01TIM SIRCY2021-10-13
5012019-08-01
5012019-08-01
5012018-08-01
5012017-08-01
5012017-08-01TIM SIRCY2019-04-25
5012016-08-01TIM SIRCY2019-05-16
5012013-08-01PATTI SWILLINGER-HAAS
5012012-08-01JOSEPH TACINELLI
5012011-08-01JOSEPH TACINELLI
5012010-08-01JOSEPH TACINELLI
5012009-08-01JOSEPH TACINELLI

Form 5500 Responses for USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN

2023: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-08-01Type of plan entitySingle employer plan
2023-08-01Submission has been amendedNo
2023-08-01This submission is the final filingNo
2023-08-01This return/report is a short plan year return/report (less than 12 months)No
2023-08-01Plan is a collectively bargained planNo
2023-08-01Plan funding arrangement – InsuranceYes
2023-08-01Plan funding arrangement – General assets of the sponsorYes
2023-08-01Plan benefit arrangement – InsuranceYes
2023-08-01Plan benefit arrangement – General assets of the sponsorYes
2022: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-08-01Type of plan entitySingle employer plan
2022-08-01Submission has been amendedNo
2022-08-01This submission is the final filingNo
2022-08-01This return/report is a short plan year return/report (less than 12 months)No
2022-08-01Plan is a collectively bargained planNo
2022-08-01Plan funding arrangement – InsuranceYes
2022-08-01Plan funding arrangement – General assets of the sponsorYes
2022-08-01Plan benefit arrangement – InsuranceYes
2022-08-01Plan benefit arrangement – General assets of the sponsorYes
2021: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Submission has been amendedNo
2021-08-01This submission is the final filingNo
2021-08-01This return/report is a short plan year return/report (less than 12 months)No
2021-08-01Plan is a collectively bargained planNo
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan funding arrangement – General assets of the sponsorYes
2021-08-01Plan benefit arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – General assets of the sponsorYes
2020: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Submission has been amendedNo
2020-08-01This submission is the final filingNo
2020-08-01This return/report is a short plan year return/report (less than 12 months)No
2020-08-01Plan is a collectively bargained planNo
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan funding arrangement – General assets of the sponsorYes
2020-08-01Plan benefit arrangement – InsuranceYes
2020-08-01Plan benefit arrangement – General assets of the sponsorYes
2019: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Submission has been amendedYes
2019-08-01This submission is the final filingNo
2019-08-01This return/report is a short plan year return/report (less than 12 months)No
2019-08-01Plan is a collectively bargained planNo
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan funding arrangement – General assets of the sponsorYes
2019-08-01Plan benefit arrangement – InsuranceYes
2019-08-01Plan benefit arrangement – General assets of the sponsorYes
2018: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-08-01Type of plan entitySingle employer plan
2018-08-01Submission has been amendedNo
2018-08-01This submission is the final filingNo
2018-08-01This return/report is a short plan year return/report (less than 12 months)No
2018-08-01Plan is a collectively bargained planNo
2018-08-01Plan funding arrangement – InsuranceYes
2018-08-01Plan funding arrangement – General assets of the sponsorYes
2018-08-01Plan benefit arrangement – InsuranceYes
2018-08-01Plan benefit arrangement – General assets of the sponsorYes
2017: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Submission has been amendedYes
2017-08-01This submission is the final filingNo
2017-08-01This return/report is a short plan year return/report (less than 12 months)No
2017-08-01Plan is a collectively bargained planNo
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan funding arrangement – General assets of the sponsorYes
2017-08-01Plan benefit arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – General assets of the sponsorYes
2016: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Submission has been amendedYes
2016-08-01This submission is the final filingNo
2016-08-01This return/report is a short plan year return/report (less than 12 months)No
2016-08-01Plan is a collectively bargained planNo
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan funding arrangement – General assets of the sponsorYes
2016-08-01Plan benefit arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – General assets of the sponsorYes
2013: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan funding arrangement – General assets of the sponsorYes
2013-08-01Plan benefit arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – General assets of the sponsorYes
2012: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Submission has been amendedNo
2012-08-01This submission is the final filingNo
2012-08-01This return/report is a short plan year return/report (less than 12 months)No
2012-08-01Plan is a collectively bargained planNo
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan funding arrangement – General assets of the sponsorYes
2012-08-01Plan benefit arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – General assets of the sponsorYes
2011: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Submission has been amendedNo
2011-08-01This submission is the final filingNo
2011-08-01This return/report is a short plan year return/report (less than 12 months)No
2011-08-01Plan is a collectively bargained planNo
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan funding arrangement – General assets of the sponsorYes
2011-08-01Plan benefit arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – General assets of the sponsorYes
2010: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2010 form 5500 responses
2010-08-01Type of plan entitySingle employer plan
2010-08-01Submission has been amendedNo
2010-08-01This submission is the final filingNo
2010-08-01This return/report is a short plan year return/report (less than 12 months)No
2010-08-01Plan is a collectively bargained planNo
2010-08-01Plan funding arrangement – InsuranceYes
2010-08-01Plan funding arrangement – General assets of the sponsorYes
2010-08-01Plan benefit arrangement – InsuranceYes
2010-08-01Plan benefit arrangement – General assets of the sponsorYes
2009: USUI MEDICAL, DENTAL AND VISION PLAN, EFFECTIVE AUGUST 1, 2006, A PROGRAM UNDER THE USUI INTERNATIONAL GROUP HEALTH & WELFARE PLAN 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Submission has been amendedNo
2009-08-01This submission is the final filingNo
2009-08-01This return/report is a short plan year return/report (less than 12 months)No
2009-08-01Plan is a collectively bargained planNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan funding arrangement – General assets of the sponsorYes
2009-08-01Plan benefit arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BGJ7
Policy instance 1
Insurance contract or identification numberG000BGJ7
Number of Individuals Covered713
Insurance policy start date2023-08-01
Insurance policy end date2024-07-31
Total amount of commissions paid to insurance brokerUSD $22,709
Total amount of fees paid to insurance companyUSD $19,766
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D; TERM LIFE VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $355,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BGJ7
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BGJ7
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BGJ7
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BGJ7
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number246058
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number246058
Policy instance 1
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number033-2321-03
Policy instance 1
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number033-2321-03
Policy instance 1
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number033-2321-03
Policy instance 1
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number033-2321-03
Policy instance 1

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