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SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 401k Plan overview

Plan NameSUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN
Plan identification number 501

SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE 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)
  • Prepaid legal
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC. has sponsored the creation of one or more 401k plans.

Company Name:THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC.
Employer identification number (EIN):751835298
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2014-11-19
Company Identification Number: 106329899

More information about THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01CATHERINE OLIVIERI2024-07-10
5012022-01-01CATHERINE OLIVIERI2023-06-28
5012021-01-01CATHERINE OLIVIERI2022-07-22
5012020-01-01CATHERINE OLIVIERI2021-07-12
5012019-01-01CATHERINE OLIVIERI2020-07-10
5012018-01-01
5012017-01-01ROBERT GREEN
5012016-01-01ROBERT GREEN
5012015-01-01ROBERT GREEN ROBERT GREEN2016-07-26
5012014-01-01ROBERT GREEN
5012013-01-01KATIE MERRELL KATIE MERRELL2014-06-24
5012012-01-01KAY ROHLMAN
5012011-01-01KAY ROHLMAN
5012010-01-01KAY ROHLMAN

Plan Statistics for SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN

401k plan membership statisitcs for SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN

Measure Date Value
2023: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01391
Total number of active participants reported on line 7a of the Form 55002023-01-01407
Number of retired or separated participants receiving benefits2023-01-014
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01411
Number of employers contributing to the scheme2023-01-010
2022: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01239
Total number of active participants reported on line 7a of the Form 55002022-01-01338
Number of retired or separated participants receiving benefits2022-01-018
Number of other retired or separated participants entitled to future benefits2022-01-016
Total of all active and inactive participants2022-01-01352
Number of employers contributing to the scheme2022-01-010
2021: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01211
Total number of active participants reported on line 7a of the Form 55002021-01-01254
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01254
Number of employers contributing to the scheme2021-01-010
2020: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01180
Total number of active participants reported on line 7a of the Form 55002020-01-01207
Number of retired or separated participants receiving benefits2020-01-013
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01210
Number of employers contributing to the scheme2020-01-010
2019: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01172
Total number of active participants reported on line 7a of the Form 55002019-01-01178
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01179
Number of employers contributing to the scheme2019-01-010
2018: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0162
Total number of active participants reported on line 7a of the Form 55002018-01-0155
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0155
2017: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0171
Total number of active participants reported on line 7a of the Form 55002017-01-0155
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0155
2016: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0188
Total number of active participants reported on line 7a of the Form 55002016-01-0181
Total of all active and inactive participants2016-01-0181
2015: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01100
Total number of active participants reported on line 7a of the Form 55002015-01-0194
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0194
2014: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01104
Total number of active participants reported on line 7a of the Form 55002014-01-0192
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0192
2013: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01122
Total number of active participants reported on line 7a of the Form 55002013-01-01101
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01101
2012: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01122
Total number of active participants reported on line 7a of the Form 55002012-01-01101
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01101
2011: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01110
Total number of active participants reported on line 7a of the Form 55002011-01-0190
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0190
2010: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01110
Total number of active participants reported on line 7a of the Form 55002010-01-01101
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010

Form 5500 Responses for SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN

2023: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: SUSAN G KOMEN BREAST CANCER FOUNDATION FLEXIBLE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACAF
Policy instance 5
Insurance contract or identification numberGLUG0ACAF
Number of Individuals Covered408
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $8,480
Total amount of fees paid to insurance companyUSD $4,435
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $217,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number302600
Policy instance 4
Insurance contract or identification number302600
Number of Individuals Covered55
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,754
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $10,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL-6185-21
Policy instance 3
Insurance contract or identification number4EL-6185-21
Number of Individuals Covered408
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $210
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5729880
Policy instance 2
Insurance contract or identification number5729880
Number of Individuals Covered820
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $17,882
Total amount of fees paid to insurance companyUSD $746
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $352,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701719
Policy instance 1
Insurance contract or identification number701719
Number of Individuals Covered565
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $25,190
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,213,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701719
Policy instance 1
Insurance contract or identification number701719
Number of Individuals Covered549
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $107,294
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,405,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5729880
Policy instance 2
Insurance contract or identification number5729880
Number of Individuals Covered765
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $15,520
Total amount of fees paid to insurance companyUSD $702
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $306,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL-6185-21
Policy instance 3
Insurance contract or identification number4EL-6185-21
Number of Individuals Covered338
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $210
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACAF
Policy instance 4
Insurance contract or identification numberGLUG0ACAF
Number of Individuals Covered388
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $7,141
Total amount of fees paid to insurance companyUSD $4,868
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $188,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACAF
Policy instance 4
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL-6185-20
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5729880
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701719
Policy instance 1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701719
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5729880
Policy instance 2
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL-6185-19
Policy instance 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACAF
Policy instance 4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0ACAF
Policy instance 5
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27502
Policy instance 4
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL-6185-18
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5729880
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701719
Policy instance 1

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