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FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameFORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN
Plan identification number 501

FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

FORT WAYNE MEDICAL EDUCATION PROGRAM has sponsored the creation of one or more 401k plans.

Company Name:FORT WAYNE MEDICAL EDUCATION PROGRAM
Employer identification number (EIN):356049685
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-04-01

Plan Statistics for FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN

Measure Date Value
2019: FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01101
Total number of active participants reported on line 7a of the Form 55002019-04-01110
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01110

Form 5500 Responses for FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN

2019: FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01First time form 5500 has been submittedYes
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00499155
Policy instance 1
Insurance contract or identification number00499155
Number of Individuals Covered110
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $7,659
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, OPTIONAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $65,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,659
Additional information about fees paid to insurance brokerCONTRACT 0009L771
Insurance broker organization code?3
PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA (National Association of Insurance Commissioners NAIC id number: 95436 )
Policy contract numberH_190069_L
Policy instance 2
Insurance contract or identification numberH_190069_L
Number of Individuals Covered216
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $72,504
Welfare Benefit Premiums Paid to CarrierUSD $1,132,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $72,504
Additional information about fees paid to insurance brokerCONTRACT H_190069_L
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10166041001
Policy instance 3
Insurance contract or identification number10166041001
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $507
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $507
Additional information about fees paid to insurance brokerCONTRACT 10166041001 CONTRACT 10226061001
Insurance broker organization code?3

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