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| Plan Name | LIFE SENIOR SERVICES LIFE AND ADD PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | LIFE SENIOR SERVICES, INC. |
| Employer identification number (EIN): | 731043783 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2019-04-01 | ALYSHA HILTBRAND | 2020-07-01 | ||
| 502 | 2018-04-01 | ALYSHA HILTBRAND | 2019-09-26 | ||
| 502 | 2017-04-01 | ALYSHA HILTBRAND | 2019-09-26 | ||
| 502 | 2016-04-01 | ALYSHA HILTBRAND | 2019-09-26 |
| 2019: LIFE SENIOR SERVICES LIFE AND ADD PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | This submission is the final filing | Yes |
| 2019-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: LIFE SENIOR SERVICES LIFE AND ADD PLAN 2018 form 5500 responses | ||
| 2018-04-01 | Type of plan entity | Single employer plan |
| 2018-04-01 | Plan funding arrangement – Insurance | Yes |
| 2018-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: LIFE SENIOR SERVICES LIFE AND ADD PLAN 2017 form 5500 responses | ||
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: LIFE SENIOR SERVICES LIFE AND ADD PLAN 2016 form 5500 responses | ||
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | First time form 5500 has been submitted | Yes |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 371243 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 371243001 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 371243001 |
| Policy instance | 1 |
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