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VAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN 401k Plan overview

Plan NameVAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN
Plan identification number 501

VAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

VAN DE POL ENTERPRISES has sponsored the creation of one or more 401k plans.

Company Name:VAN DE POL ENTERPRISES
Employer identification number (EIN):942428381
NAIC Classification:324110
NAIC Description:Petroleum Refineries

Additional information about VAN DE POL ENTERPRISES

Jurisdiction of Incorporation: California Department of State
Incorporation Date: 1977-07-01
Company Identification Number: C0819422
Legal Registered Office Address: 5602 Pintail Ct

Stockton
United States of America (USA)
95207

More information about VAN DE POL ENTERPRISES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012012-01-01JORDAN SHIELDS
5012012-01-01

Plan Statistics for VAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN

401k plan membership statisitcs for VAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN

Measure Date Value
2012: VAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01131
Total number of active participants reported on line 7a of the Form 55002012-01-01133
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 participants2012-01-01133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01133
Number of participants with account balances2012-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Form 5500 Responses for VAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN

2012: VAN DE POL ENTERPRISES HEALTH REIMBURSEMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
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 – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00607425
Policy instance 1
Insurance contract or identification number00607425
Number of Individuals Covered133
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $59,077
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $548,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,077
Insurance broker organization code?3
Insurance broker namePAUL SACHS

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