401k Plan data: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN plan

LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN
Plan identification number	506

LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

LUMEDX CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: LUMEDX CORPORATION

Employer identification number (EIN): 943188965

NAIC Classification: 561430

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2020-06-01 JEFFREY WHIPPLE 2021-11-11
506 2019-06-01 JAY SONI 2021-02-01
506 2017-06-01
506 2016-06-01
506 2015-06-01 JAY SONI
506 2014-06-01 JAGMIT SONJ
506 2013-06-01 JAY SONI
506 2012-06-01 JAY SONI
506 2011-06-01 JAY SONI
506 2009-06-01 JAY SONI

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
506	2020-06-01	JEFFREY WHIPPLE	2021-11-11
506	2019-06-01	JAY SONI	2021-02-01
506	2017-06-01
506	2016-06-01
506	2015-06-01	JAY SONI
506	2014-06-01	JAGMIT SONJ
506	2013-06-01	JAY SONI
506	2012-06-01	JAY SONI
506	2011-06-01	JAY SONI
506	2009-06-01	JAY SONI

Plan Statistics for LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN

401k plan membership statisitcs for LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN

Measure Date Value
2020: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-06-01 101
Total number of active participants reported on line 7a of the Form 5500 2020-06-01 64
Number of retired or separated participants receiving benefits 2020-06-01 4
Number of other retired or separated participants entitled to future benefits 2020-06-01 0
Total of all active and inactive participants 2020-06-01 68
Number of employers contributing to the scheme 2020-06-01 0
2019: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-06-01 104
Total number of active participants reported on line 7a of the Form 5500 2019-06-01 101
Number of retired or separated participants receiving benefits 2019-06-01 1
Number of other retired or separated participants entitled to future benefits 2019-06-01 0
Total of all active and inactive participants 2019-06-01 102
Number of employers contributing to the scheme 2019-06-01 0
2017: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-06-01 112
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 107
Number of retired or separated participants receiving benefits 2017-06-01 0
Number of other retired or separated participants entitled to future benefits 2017-06-01 0
Total of all active and inactive participants 2017-06-01 107
Number of employers contributing to the scheme 2017-06-01 0
2016: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 143
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 112
Number of retired or separated participants receiving benefits 2016-06-01 0
Number of other retired or separated participants entitled to future benefits 2016-06-01 0
Total of all active and inactive participants 2016-06-01 112
2015: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 143
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 143
Number of retired or separated participants receiving benefits 2015-06-01 0
Number of other retired or separated participants entitled to future benefits 2015-06-01 0
Total of all active and inactive participants 2015-06-01 143
2014: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 142
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 143
Number of retired or separated participants receiving benefits 2014-06-01 0
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 143
2013: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 132
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 142
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 142
2012: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 128
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 132
Number of retired or separated participants receiving benefits 2012-06-01 0
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 132
2011: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 135
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 128
Number of retired or separated participants receiving benefits 2011-06-01 0
Number of other retired or separated participants entitled to future benefits 2011-06-01 0
Total of all active and inactive participants 2011-06-01 128
2009: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-01 133
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 136
Number of retired or separated participants receiving benefits 2009-06-01 0
Number of other retired or separated participants entitled to future benefits 2009-06-01 0
Total of all active and inactive participants 2009-06-01 136

Measure	Date	Value
2020: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-06-01	101
Total number of active participants reported on line 7a of the Form 5500	2020-06-01	64
Number of retired or separated participants receiving benefits	2020-06-01	4
Number of other retired or separated participants entitled to future benefits	2020-06-01	0
Total of all active and inactive participants	2020-06-01	68
Number of employers contributing to the scheme	2020-06-01	0
2019: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-06-01	104
Total number of active participants reported on line 7a of the Form 5500	2019-06-01	101
Number of retired or separated participants receiving benefits	2019-06-01	1
Number of other retired or separated participants entitled to future benefits	2019-06-01	0
Total of all active and inactive participants	2019-06-01	102
Number of employers contributing to the scheme	2019-06-01	0
2017: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	112
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	107
Number of retired or separated participants receiving benefits	2017-06-01	0
Number of other retired or separated participants entitled to future benefits	2017-06-01	0
Total of all active and inactive participants	2017-06-01	107
Number of employers contributing to the scheme	2017-06-01	0
2016: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	143
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	112
Number of retired or separated participants receiving benefits	2016-06-01	0
Number of other retired or separated participants entitled to future benefits	2016-06-01	0
Total of all active and inactive participants	2016-06-01	112
2015: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	143
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	143
Number of retired or separated participants receiving benefits	2015-06-01	0
Number of other retired or separated participants entitled to future benefits	2015-06-01	0
Total of all active and inactive participants	2015-06-01	143
2014: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	142
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	143
Number of retired or separated participants receiving benefits	2014-06-01	0
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	143
2013: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	132
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	142
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	142
2012: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	128
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	132
Number of retired or separated participants receiving benefits	2012-06-01	0
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	132
2011: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	135
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	128
Number of retired or separated participants receiving benefits	2011-06-01	0
Number of other retired or separated participants entitled to future benefits	2011-06-01	0
Total of all active and inactive participants	2011-06-01	128
2009: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	133
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	136
Number of retired or separated participants receiving benefits	2009-06-01	0
Number of other retired or separated participants entitled to future benefits	2009-06-01	0
Total of all active and inactive participants	2009-06-01	136

Form 5500 Responses for LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN

2020: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Submission has been amended	No
2016-06-01	This submission is the final filing	No
2016-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-06-01	Plan is a collectively bargained plan	No
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Submission has been amended	No
2015-06-01	This submission is the final filing	No
2015-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-06-01	Plan is a collectively bargained plan	No
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2014: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	No
2014-06-01	This submission is the final filing	No
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Submission has been amended	No
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Submission has been amended	No
2012-06-01	This submission is the final filing	No
2012-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-06-01	Plan is a collectively bargained plan	No
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2011: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Submission has been amended	No
2011-06-01	This submission is the final filing	No
2011-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-06-01	Plan is a collectively bargained plan	No
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2009: LUMEDX CORPORATION GROUP HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	Submission has been amended	No
2009-06-01	This submission is the final filing	No
2009-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-06-01	Plan is a collectively bargained plan	No
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number	12217689
Policy instance	4
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	BTA-121094
Policy instance	3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	884758G
Policy instance	2
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	9381
Policy instance	1
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E3293198
Policy instance	5
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	BTA-121094
Policy instance	5
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	100-4788-00
Policy instance	3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	9381
Policy instance	1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number	12217689
Policy instance	2
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	4005806
Policy instance	6
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E3293198
Policy instance	4
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E3293198
Policy instance	6
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number	10011959
Policy instance	1
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	100-4788-00
Policy instance	2
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	BTA-121094
Policy instance	3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number	12217689
Policy instance	4
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	9381
Policy instance	5
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E3293198
Policy instance	6
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number	12217689
Policy instance	4
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	BTA-121094
Policy instance	3
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	100-4788-00
Policy instance	2
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number	10011959
Policy instance	1
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	9381
Policy instance	5
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E3293198
Policy instance	6
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	100-4788-00
Policy instance	2
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	BTA-121094
Policy instance	3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number	12217689
Policy instance	4
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	9381
Policy instance	5
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number	10011959
Policy instance	1
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	BTA-121094
Policy instance	6
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E3293198
Policy instance	5
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	100-4788-00
Policy instance	4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number	12217689
Policy instance	3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	9381
Policy instance	2
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	1012843
Policy instance	1
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number	GTP0009118940
Policy instance	6
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E3293198
Policy instance	5
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number	100-4788-00
Policy instance	4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number	12217689
Policy instance	3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	9381
Policy instance	2
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	1012843
Policy instance	1

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Company Name:	LUMEDX CORPORATION
Employer identification number (EIN):	943188965
NAIC Classification:	561430