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C & A STAR BENEFIT PLAN 401k Plan overview

Plan NameC & A STAR BENEFIT PLAN
Plan identification number 501

C & A STAR 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
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

CHEYENNE & ARAPAHO TRIBES has sponsored the creation of one or more 401k plans.

Company Name:CHEYENNE & ARAPAHO TRIBES
Employer identification number (EIN):730710910
NAIC Classification:713200
NAIC Description: Gambling Industries

Form 5500 Filing Information

Submission information for form 5500 for 401k plan C & A STAR BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-03-01HOGANTAYLOR LLP PREPARER HOGANTAYLOR LLP PREPARER2017-10-24
5012015-03-01HOGANTAYLOR LLP PREPARER

Plan Statistics for C & A STAR BENEFIT PLAN

401k plan membership statisitcs for C & A STAR BENEFIT PLAN

Measure Date Value
2016: C & A STAR BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-011,032
Total number of active participants reported on line 7a of the Form 55002016-03-011,093
Number of retired or separated participants receiving benefits2016-03-014
Total of all active and inactive participants2016-03-011,097
Total participants2016-03-011,097
2015: C & A STAR BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-011,318
Total number of active participants reported on line 7a of the Form 55002015-03-011,153
Total of all active and inactive participants2015-03-011,153
Total participants2015-03-011,153

Form 5500 Responses for C & A STAR BENEFIT PLAN

2016: C & A STAR BENEFIT PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Submission has been amendedNo
2016-03-01This submission is the final filingNo
2016-03-01This return/report is a short plan year return/report (less than 12 months)No
2016-03-01Plan is a collectively bargained planNo
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – InsuranceYes
2015: C & A STAR BENEFIT PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)No
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number139632
Policy instance 1
Insurance contract or identification number139632
Number of Individuals Covered1565
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $205,575
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,445,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $205,575
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number2020
Policy instance 2
Insurance contract or identification number2020
Number of Individuals Covered1137
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $38,912
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $389,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,912
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberLG608
Policy instance 3
Insurance contract or identification numberLG608
Number of Individuals Covered245
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $29,858
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $138,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,504
Insurance broker organization code?3
Insurance broker nameSEXTON & ASSOC INS AGCY INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number51817
Policy instance 4
Insurance contract or identification number51817
Number of Individuals Covered1162
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $80,798
Total amount of fees paid to insurance companyUSD $449
Life 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 $807,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $80,798
Insurance broker organization code?3
Amount paid for insurance broker fees449
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number30047060
Policy instance 5
Insurance contract or identification number30047060
Number of Individuals Covered1182
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $7,941
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,941
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.

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