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| Plan Name | GLOBAL UPRISING PBC DBA COTOPAXI HEALTH PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GLOBAL UPRISING, PBC |
| Employer identification number (EIN): | 463822130 |
| NAIC Classification: | 451110 |
| NAIC Description: | Sporting Goods Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-01-01 | GARY BOWEN | 2023-07-26 |
| Measure | Date | Value |
|---|---|---|
| 2022: GLOBAL UPRISING PBC DBA COTOPAXI HEALTH PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 176 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| 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 | 176 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2022: GLOBAL UPRISING PBC DBA COTOPAXI HEALTH PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | First time form 5500 has been submitted | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 628922 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 628922 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | SGM611510 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||
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