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LIFE AND AD&D PLAN 401k Plan overview

Plan NameLIFE AND AD&D PLAN
Plan identification number 504

LIFE AND AD&D PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PROTHERA INC. has sponsored the creation of one or more 401k plans.

Company Name:PROTHERA INC.
Employer identification number (EIN):880487638
NAIC Classification:325410

Additional information about PROTHERA INC.

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 2001-01-25
Company Identification Number: 20011196269
Legal Registered Office Address: 10439 DOUBLE R BLVD

RENO
United States of America (USA)
89521

More information about PROTHERA INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE AND AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042022-03-01ROBERT HENDRIKS2023-08-27
5042021-03-01DOUG HARVEY2022-08-01
5042020-03-01DOUG HARVEY2021-08-12
5042019-03-01DOUGLAS HARVEY2020-09-17
5042018-03-01DOUGLAS HARVEY2019-12-16
5042017-03-01

Plan Statistics for LIFE AND AD&D PLAN

401k plan membership statisitcs for LIFE AND AD&D PLAN

Measure Date Value
2022: LIFE AND AD&D PLAN 2022 401k membership
Total participants, beginning-of-year2022-03-01143
Total number of active participants reported on line 7a of the Form 55002022-03-01144
Number of retired or separated participants receiving benefits2022-03-010
Number of other retired or separated participants entitled to future benefits2022-03-010
Total of all active and inactive participants2022-03-01144
Number of employers contributing to the scheme2022-03-010
2021: LIFE AND AD&D PLAN 2021 401k membership
Total participants, beginning-of-year2021-03-01157
Total number of active participants reported on line 7a of the Form 55002021-03-01143
Number of retired or separated participants receiving benefits2021-03-010
Number of other retired or separated participants entitled to future benefits2021-03-010
Total of all active and inactive participants2021-03-01143
Number of employers contributing to the scheme2021-03-010
2020: LIFE AND AD&D PLAN 2020 401k membership
Total participants, beginning-of-year2020-03-01124
Total number of active participants reported on line 7a of the Form 55002020-03-01157
Number of retired or separated participants receiving benefits2020-03-010
Number of other retired or separated participants entitled to future benefits2020-03-010
Total of all active and inactive participants2020-03-01157
Number of employers contributing to the scheme2020-03-010
2019: LIFE AND AD&D PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-01123
Total number of active participants reported on line 7a of the Form 55002019-03-01118
Number of retired or separated participants receiving benefits2019-03-016
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-01124
Number of employers contributing to the scheme2019-03-010
2018: LIFE AND AD&D PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-01127
Total number of active participants reported on line 7a of the Form 55002018-03-01123
Number of retired or separated participants receiving benefits2018-03-010
Number of other retired or separated participants entitled to future benefits2018-03-010
Total of all active and inactive participants2018-03-01123
Number of employers contributing to the scheme2018-03-010
2017: LIFE AND AD&D PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-01127
Total number of active participants reported on line 7a of the Form 55002017-03-01127
Number of retired or separated participants receiving benefits2017-03-011
Number of other retired or separated participants entitled to future benefits2017-03-010
Total of all active and inactive participants2017-03-01128

Form 5500 Responses for LIFE AND AD&D PLAN

2022: LIFE AND AD&D PLAN 2022 form 5500 responses
2022-03-01Type of plan entitySingle employer plan
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan benefit arrangement – InsuranceYes
2021: LIFE AND AD&D PLAN 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – InsuranceYes
2020: LIFE AND AD&D PLAN 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – InsuranceYes
2019: LIFE AND AD&D PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – InsuranceYes
2018: LIFE AND AD&D PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – InsuranceYes
2017: LIFE AND AD&D PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01First time form 5500 has been submittedYes
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number196035
Policy instance 1
Insurance contract or identification number196035
Number of Individuals Covered142
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $726
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $726
Amount paid for insurance broker fees0
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number196035
Policy instance 1
Insurance contract or identification number196035
Number of Individuals Covered143
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $782
Total amount of fees paid to insurance companyUSD $31
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $782
Amount paid for insurance broker fees31
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number196035
Policy instance 1
Insurance contract or identification number196035
Number of Individuals Covered157
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $336
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $336
Amount paid for insurance broker fees0
Insurance broker organization code?3
KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )
Policy contract numberGLT-24004
Policy instance 1
Insurance contract or identification numberGLT-24004
Number of Individuals Covered118
Insurance policy start date2019-03-01
Insurance policy end date2020-02-28
Total amount of commissions paid to insurance brokerUSD $645
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $645
Amount paid for insurance broker fees0
Insurance broker organization code?3
KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )
Policy contract numberGLT-24004
Policy instance 1
Insurance contract or identification numberGLT-24004
Number of Individuals Covered123
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $9,952
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $98,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,952
Amount paid for insurance broker fees0
Insurance broker organization code?3
KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )
Policy contract numberGLT-24004
Policy instance 1
Insurance contract or identification numberGLT-24004
Number of Individuals Covered128
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $636
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $636
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameLETTY QUINTANA

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