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| Plan Name | USHV MANAGEMENT, LLC WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | USHV MANAGEMENT, LLC |
| Employer identification number (EIN): | 874006946 |
| NAIC Classification: | 551112 |
| NAIC Description: | Offices of Other Holding Companies |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-04-01 | SUSAN SPIER | 2023-10-06 |
| Measure | Date | Value |
|---|---|---|
| 2022: USHV MANAGEMENT, LLC WELFARE BENEFIT PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-04-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 104 |
| Number of retired or separated participants receiving benefits | 2022-04-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 3 |
| Total of all active and inactive participants | 2022-04-01 | 110 |
| Number of employers contributing to the scheme | 2022-04-01 | 0 |
| 2022: USHV MANAGEMENT, LLC WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | First time form 5500 has been submitted | Yes |
| 2022-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AVESIS INSURANCE INCORPORATED (National Association of Insurance Commissioners NAIC id number: 11163 ) | |||||||||||||||||||||||||||||||||||||||
| Policy contract number | 11001-1473 | ||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||
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| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) | |||||||||||||||||||||||||||||||||||||||
| Policy contract number | 13444 | ||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1059738 | ||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||
| Policy contract number | GUC0C3FP | ||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||
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