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| Plan Name | URSA LOGISTICS GROUP HEALTH & WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | URSA LOGISTICS |
| Employer identification number (EIN): | 391922868 |
| NAIC Classification: | 484110 |
| NAIC Description: | General Freight Trucking, Local |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-01-01 | ||||
| 501 | 2018-01-01 | JEFFREY LAMPSA |
| Measure | Date | Value |
|---|---|---|
| 2019: URSA LOGISTICS GROUP HEALTH & WELFARE PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 209 |
| Total of all active and inactive participants | 2019-01-01 | 209 |
| Total participants | 2019-01-01 | 209 |
| 2018: URSA LOGISTICS GROUP HEALTH & WELFARE PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 174 |
| Total of all active and inactive participants | 2018-01-01 | 174 |
| Total participants | 2018-01-01 | 174 |
| 2019: URSA LOGISTICS GROUP HEALTH & WELFARE PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: URSA LOGISTICS GROUP HEALTH & WELFARE PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| WPS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 10159 ) | |
| Policy contract number | 10011810 |
| Policy instance | 1 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | W80488 |
| Policy instance | 2 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | G1400 |
| Policy instance | 1 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | G1400 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) | |
| Policy contract number | 00252870 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) | |
| Policy contract number | 00252870 |
| Policy instance | 4 |
| COMPCARE HEALTH SERVICES INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95693 ) | |
| Policy contract number | 00252870 |
| Policy instance | 5 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) | |
| Policy contract number | 572095 |
| Policy instance | 6 |
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