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| Plan Name | JUPITERONE HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | JUPITERONE, INC. |
| Employer identification number (EIN): | 851643254 |
| NAIC Classification: | 511210 |
| NAIC Description: | Software Publishers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-08-01 | KATHRYN WALENTY | 2024-11-11 | ||
| 501 | 2022-08-01 | AMY DEVERS | 2023-11-08 |
| 2023: JUPITERONE HEALTH AND WELFARE PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-08-01 | Type of plan entity | Single employer plan |
| 2023-08-01 | Plan funding arrangement – Insurance | Yes |
| 2023-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: JUPITERONE HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | First time form 5500 has been submitted | Yes |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |||||||||||||||||||||||||||||
| Policy contract number | 14174941-1001 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||
| Policy contract number | 38157 | ||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||
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| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |||||||||||||||||||||||||||||
| Policy contract number | 14174941-1001 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||
| Policy contract number | 0038157 | ||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||
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