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AHTNA-UGSOA WELFARE BENEFIT PLAN 401k Plan overview

Plan NameAHTNA-UGSOA WELFARE BENEFIT PLAN
Plan identification number 501

AHTNA-UGSOA WELFARE BENEFIT 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

AHTNA-UGSOA has sponsored the creation of one or more 401k plans.

Company Name:AHTNA-UGSOA
Employer identification number (EIN):453560335
NAIC Classification:813930
NAIC Description:Labor Unions and Similar Labor Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AHTNA-UGSOA WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012014-01-01ENRIQUE MARTINEZ
5012013-01-01ASAEL SAAVEDRA ASAEL SAAVEDRA2014-07-23
5012012-01-01ASAEL SAAVEDRA ASAEL SAAVEDRA2013-10-10

Plan Statistics for AHTNA-UGSOA WELFARE BENEFIT PLAN

401k plan membership statisitcs for AHTNA-UGSOA WELFARE BENEFIT PLAN

Measure Date Value
2014: AHTNA-UGSOA WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01421
Total number of active participants reported on line 7a of the Form 55002014-01-01406
Number of retired or separated participants receiving benefits2014-01-011
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01407
2013: AHTNA-UGSOA WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01441
Total number of active participants reported on line 7a of the Form 55002013-01-01433
Number of retired or separated participants receiving benefits2013-01-012
Total of all active and inactive participants2013-01-01435
2012: AHTNA-UGSOA WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01425
Total number of active participants reported on line 7a of the Form 55002012-01-01430
Number of retired or separated participants receiving benefits2012-01-011
Total of all active and inactive participants2012-01-01431

Form 5500 Responses for AHTNA-UGSOA WELFARE BENEFIT PLAN

2014: AHTNA-UGSOA WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: AHTNA-UGSOA WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: AHTNA-UGSOA WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0846900
Policy instance 1
Insurance contract or identification number0846900
Number of Individuals Covered2102
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $77,912
Total amount of fees paid to insurance companyUSD $1,425
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
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 $2,986,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $77,912
Amount paid for insurance broker fees1425
Additional information about fees paid to insurance brokerPM CROSS-SALE
Insurance broker organization code?3
Insurance broker nameDANIEL SANCHEZ
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0846900
Policy instance 1
Insurance contract or identification number0846900
Number of Individuals Covered2349
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $141,428
Total amount of fees paid to insurance companyUSD $55,224
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,725,490
Commission paid to Insurance BrokerUSD $141,428
Amount paid for insurance broker fees55224
Additional information about fees paid to insurance brokerPM CROSS-SALE
Insurance broker organization code?3
Insurance broker nameDANIEL SANCHEZ
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract number12003295
Policy instance 1
Insurance contract or identification number12003295
Number of Individuals Covered397
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,861
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,595
Commission paid to Insurance BrokerUSD $2,861
Insurance broker organization code?3
Insurance broker nameDANIEL SANCHEZ
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract number12003295
Policy instance 2
Insurance contract or identification number12003295
Number of Individuals Covered399
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $17,428
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $180,148
Commission paid to Insurance BrokerUSD $17,428
Insurance broker organization code?3
Insurance broker nameDANIEL SANCHEZ
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number099016
Policy instance 3
Insurance contract or identification number099016
Number of Individuals Covered787
Insurance policy start date2012-01-01
Insurance policy end date2012-12-30
Total amount of commissions paid to insurance brokerUSD $43,905
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,311,253
Commission paid to Insurance BrokerUSD $41,136
Insurance broker organization code?3
Insurance broker nameDANIEL E. SANCHEZ

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