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| Plan Name | VIA MOBILITY SERVICES WELFARE BENEFIT PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | VIA MOBILITY SERVICES |
| Employer identification number (EIN): | 840777296 |
| NAIC Classification: | 485990 |
Additional information about VIA MOBILITY SERVICES
| Jurisdiction of Incorporation: | Colorado Department of State |
| Incorporation Date: | 1978-08-25 |
| Company Identification Number: | 19871354388 |
| Legal Registered Office Address: |
2855 North 63rd Street Boulder United States of America (USA) 80301-2959 |
More information about VIA MOBILITY SERVICES
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2022-01-01 | ||||
| 502 | 2022-01-01 | WILLIAM PATTERSON | |||
| 502 | 2021-01-01 | ||||
| 502 | 2021-01-01 | WILLIAM PATTERSON | |||
| 502 | 2020-01-01 | ||||
| 502 | 2019-01-01 | ||||
| 502 | 2018-01-01 | ||||
| 502 | 2017-01-01 | WILLIAM PATTERSON | WILLIAM PATTERSON | 2018-10-08 | |
| 502 | 2016-01-01 | WILLIAM PATTERSON | WILLIAM PATTERSON | 2017-10-02 | |
| 502 | 2015-01-01 | WILLIAM PATTERSON | |||
| 502 | 2014-01-01 | SANDY SISNEROS | |||
| 502 | 2013-01-01 | SANDY SISNEROS | |||
| 502 | 2012-01-01 | SANDY SISNEROS | |||
| 502 | 2011-01-01 | SANDY SISNEROS | |||
| 502 | 2010-01-01 | SANDY SISNEROS | |||
| 502 | 2009-01-01 | SANDY SISNEROS | SANDY SISNEROS | 2010-07-27 |
| Measure | Date | Value |
|---|---|---|
| 2022: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 205 |
| Total of all active and inactive participants | 2022-01-01 | 205 |
| 2021: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 179 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 196 |
| Total of all active and inactive participants | 2021-01-01 | 196 |
| 2020: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 163 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 195 |
| Total of all active and inactive participants | 2020-01-01 | 195 |
| 2019: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 287 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 287 |
| Total of all active and inactive participants | 2019-01-01 | 287 |
| 2018: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 296 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 282 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 282 |
| 2017: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 256 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 286 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 4 |
| Total of all active and inactive participants | 2017-01-01 | 292 |
| 2016: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 254 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 249 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 6 |
| Total of all active and inactive participants | 2016-01-01 | 256 |
| 2015: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-01-01 | 244 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 256 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 8 |
| Total of all active and inactive participants | 2015-01-01 | 265 |
| 2014: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-01-01 | 261 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 235 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 5 |
| Total of all active and inactive participants | 2014-01-01 | 244 |
| 2013: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-01-01 | 229 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 249 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 10 |
| Total of all active and inactive participants | 2013-01-01 | 261 |
| 2012: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-01-01 | 218 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 222 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 5 |
| Total of all active and inactive participants | 2012-01-01 | 229 |
| 2011: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-01-01 | 208 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 218 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 218 |
| 2010: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-01-01 | 195 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 206 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 208 |
| 2009: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 194 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 195 |
| 2022: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2014 form 5500 responses | ||
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2013 form 5500 responses | ||
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2012 form 5500 responses | ||
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2010 form 5500 responses | ||
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: VIA MOBILITY SERVICES WELFARE BENEFIT PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) | |
| Policy contract number | 791486 |
| Policy instance | 4 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 000007271 |
| Policy instance | 2 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 5 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | 41235 |
| Policy instance | 3 |
| BETA HEALTH ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 81300 ) | |
| Policy contract number | 90000373 |
| Policy instance | 1 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 39360 |
| Policy instance | 2 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 7271 |
| Policy instance | 4 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 1 |
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) | |
| Policy contract number | 791486 |
| Policy instance | 5 |
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |
| Policy contract number | 791486 |
| Policy instance | 6 |
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) | |
| Policy contract number | 791486 |
| Policy instance | 7 |
| BETA HEALTH ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 81300 ) | |
| Policy contract number | 90000373 |
| Policy instance | 3 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 3 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 7271 |
| Policy instance | 6 |
| BETA HEALTH ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 81300 ) | |
| Policy contract number | 1910000 |
| Policy instance | 5 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 39360 |
| Policy instance | 4 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 35534 |
| Policy instance | 1 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-040396 |
| Policy instance | 2 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 39360 |
| Policy instance | 4 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 3 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-040396 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 35534 |
| Policy instance | 1 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 39360 |
| Policy instance | 4 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-040396 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 35534 |
| Policy instance | 1 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 3 |
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) | |
| Policy contract number | 897379-000 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 35534 |
| Policy instance | 1 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 3 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 39360 |
| Policy instance | 4 |
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) | |
| Policy contract number | 897379 ET AL |
| Policy instance | 2 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 3 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 39360 |
| Policy instance | 4 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 212112 |
| Policy instance | 1 |
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) | |
| Policy contract number | 12956 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 212112 |
| Policy instance | 1 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 3 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 39360 |
| Policy instance | 4 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05558147 |
| Policy instance | 2 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 41235 |
| Policy instance | 3 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 39360 |
| Policy instance | 4 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 212112 |
| Policy instance | 1 |