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| Plan Name | BAXALTA INCORPORATED AND SUBSIDIARIES WELFARE BENEFIT PLAN FOR ACTIVE EMPLOYEES |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BAXALTA INCORPORATED |
| Employer identification number (EIN): | 471869689 |
| NAIC Classification: | 339110 |
Additional information about BAXALTA INCORPORATED
| Jurisdiction of Incorporation: | State of Delaware Division of Corporations |
| Incorporation Date: | |
| Company Identification Number: | 5572011 |
More information about BAXALTA INCORPORATED
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2016-01-01 | JEFFREY SHOVLIN | JEFFREY SHOVLIN | 2017-10-11 | |
| 501 | 2016-01-01 | JEFFREY SHOVLIN | 2019-01-04 | ||
| 501 | 2015-07-01 | JEFFREY SHOVLIN |
| 2016: BAXALTA INCORPORATED AND SUBSIDIARIES WELFARE BENEFIT PLAN FOR ACTIVE EMPLOYEES 2016 form 5500 responses | ||
|---|---|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: BAXALTA INCORPORATED AND SUBSIDIARIES WELFARE BENEFIT PLAN FOR ACTIVE EMPLOYEES 2015 form 5500 responses | ||
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | First time form 5500 has been submitted | Yes |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 ) | |
| Policy contract number | 78554 |
| Policy instance | 1 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) | |
| Policy contract number | PD384044453201 |
| Policy instance | 13 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 3338805 |
| Policy instance | 12 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | ADDS08160 |
| Policy instance | 11 |
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) | |
| Policy contract number | A1027 |
| Policy instance | 10 |
| VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 ) | |
| Policy contract number | N/A |
| Policy instance | 9 |
| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 0 ) | |
| Policy contract number | 357743 |
| Policy instance | 8 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 402847G |
| Policy instance | 7 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 232546 |
| Policy instance | 6 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 604777 |
| Policy instance | 5 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | ABL962994 |
| Policy instance | 4 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 00281944/0001 |
| Policy instance | 3 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 162315 |
| Policy instance | 2 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) | |
| Policy contract number | GF384044453201 |
| Policy instance | 14 |
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