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| Plan Name | FAHERTY BRAND HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FAHERTY BRAND, LLC |
| Employer identification number (EIN): | 454826718 |
| NAIC Classification: | 448140 |
| NAIC Description: | Family Clothing Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-11-01 | EVANGELINE VASSILIOU | 2024-05-30 | ||
| 501 | 2021-11-01 | LAURA REHG | 2023-08-10 | ||
| 501 | 2020-11-01 | LAURA REGH | 2022-06-15 |
| 2022: FAHERTY BRAND HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-11-01 | Type of plan entity | Single employer plan |
| 2022-11-01 | Plan funding arrangement – Insurance | Yes |
| 2022-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: FAHERTY BRAND HEALTH AND WELFARE PLAN 2021 form 5500 responses | ||
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: FAHERTY BRAND HEALTH AND WELFARE PLAN 2020 form 5500 responses | ||
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | First time form 5500 has been submitted | Yes |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 300494 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 17993 |
| Policy instance | 2 |
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) | |
| Policy contract number | 10263745 |
| Policy instance | 3 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 300494 |
| Policy instance | 1 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 170333 |
| Policy instance | 2 |
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) | |
| Policy contract number | 10263745 |
| Policy instance | 3 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 300494 |
| Policy instance | 1 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 170333 |
| Policy instance | 2 |
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) | |
| Policy contract number | 10263745 |
| Policy instance | 3 |
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