401k Plan data: SHARED IMAGING HEALTH & WELFARE PLAN plan

SHARED IMAGING HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	SHARED IMAGING HEALTH & WELFARE PLAN
Plan identification number	502

SHARED IMAGING HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision

401k Sponsoring company profile

SHARED IMAGING, LLC has sponsored the creation of one or more 401k plans.

Company Name: SHARED IMAGING, LLC

Employer identification number (EIN): 261730120

NAIC Classification: 621900

Additional information about SHARED IMAGING, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2008-03-20

Company Identification Number: 0800954528

Legal Registered Office Address: 3041 WOODCREEK DR STE 200

DOWNERS GROVE
United States of America (USA)
60515

More information about SHARED IMAGING, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHARED IMAGING HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2019-01-01

Plan Statistics for SHARED IMAGING HEALTH & WELFARE PLAN

401k plan membership statisitcs for SHARED IMAGING HEALTH & WELFARE PLAN

Measure Date Value
2019: SHARED IMAGING HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 111
Total of all active and inactive participants 2019-01-01 111
Total participants 2019-01-01 111

Measure	Date	Value
2019: SHARED IMAGING HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	111
Total of all active and inactive participants	2019-01-01	111
Total participants	2019-01-01	111

Form 5500 Responses for SHARED IMAGING HEALTH & WELFARE PLAN

2019: SHARED IMAGING HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30058438

Policy instance

Insurance contract or identification number	30058438
Number of Individuals Covered	97
Insurance policy start date	2019-01-02
Insurance policy end date	2016-12-31
Total amount of commissions paid to insurance broker	USD $3,140
Total amount of fees paid to insurance company	USD $3,140
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $10,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,634
Additional information about fees paid to insurance broker	EYE COVERAGE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

160109

Policy instance

Insurance contract or identification number	160109
Number of Individuals Covered	111
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,210
Total amount of fees paid to insurance company	USD $6,210
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $4,140,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,615
Additional information about fees paid to insurance broker	LIFE, STD, LTD

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

208415

Policy instance

Insurance contract or identification number	208415
Number of Individuals Covered	103
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $325
Total amount of fees paid to insurance company	USD $325
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 Carrier	USD $2,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,496
Additional information about fees paid to insurance broker	VOLUNTARY AD&D

Potentially related plans

SHARED IMAGING SERVICES, LLC 401K / PROFIT SHARING PLAN [EIN = 391971378]

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Company Name:	SHARED IMAGING, LLC
Employer identification number (EIN):	261730120
NAIC Classification:	621900

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2008-03-20
Company Identification Number:	0800954528
Legal Registered Office Address:	3041 WOODCREEK DR STE 200 DOWNERS GROVE United States of America (USA) 60515