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TRAVEL ACCIDENT PLAN 401k Plan overview

Plan NameTRAVEL ACCIDENT PLAN
Plan identification number 509

TRAVEL ACCIDENT PLAN Benefits

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

401k Sponsoring company profile

MARSHFIELD CLINIC, INC. has sponsored the creation of one or more 401k plans.

Company Name:MARSHFIELD CLINIC, INC.
Employer identification number (EIN):390452970
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about MARSHFIELD CLINIC, INC.

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number: 90083H

More information about MARSHFIELD CLINIC, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRAVEL ACCIDENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5092015-10-01STEVEN CHRISTIANSON
5092015-08-01STEVEN CHRISTIANSON
5092014-08-01STEVEN CHRISTIANSON
5092013-08-01STEVEN CHRISTIANSON
5092012-08-01STEVEN CHRISTIANSON
5092011-08-01STEVEN CHRISTIANSON
5092009-08-01STEVEN CHRISTIANSON

Plan Statistics for TRAVEL ACCIDENT PLAN

401k plan membership statisitcs for TRAVEL ACCIDENT PLAN

Measure Date Value
2015: TRAVEL ACCIDENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-017,448
Total number of active participants reported on line 7a of the Form 55002015-10-017,744
Total of all active and inactive participants2015-10-017,744
Total participants2015-10-017,744
Total participants, beginning-of-year2015-08-017,371
Total number of active participants reported on line 7a of the Form 55002015-08-017,448
Total of all active and inactive participants2015-08-017,448
Total participants2015-08-017,448
2014: TRAVEL ACCIDENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-017,396
Total number of active participants reported on line 7a of the Form 55002014-08-017,371
Total of all active and inactive participants2014-08-017,371
Total participants2014-08-017,371
2013: TRAVEL ACCIDENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-017,865
Total number of active participants reported on line 7a of the Form 55002013-08-017,752
Total of all active and inactive participants2013-08-017,752
Total participants2013-08-017,752
2012: TRAVEL ACCIDENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-018,235
Total number of active participants reported on line 7a of the Form 55002012-08-017,865
Total of all active and inactive participants2012-08-017,865
Total participants2012-08-017,865
2011: TRAVEL ACCIDENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-018,065
Total number of active participants reported on line 7a of the Form 55002011-08-018,235
Total of all active and inactive participants2011-08-018,235
Total participants2011-08-018,235
2009: TRAVEL ACCIDENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-017,313
Total number of active participants reported on line 7a of the Form 55002009-08-017,276
Total of all active and inactive participants2009-08-017,276
Total participants2009-08-017,276

Form 5500 Responses for TRAVEL ACCIDENT PLAN

2015: TRAVEL ACCIDENT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2015-08-01Type of plan entitySingle employer plan
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: TRAVEL ACCIDENT PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)No
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: TRAVEL ACCIDENT PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: TRAVEL ACCIDENT PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Submission has been amendedNo
2012-08-01This submission is the final filingNo
2012-08-01This return/report is a short plan year return/report (less than 12 months)No
2012-08-01Plan is a collectively bargained planNo
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: TRAVEL ACCIDENT PLAN 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Submission has been amendedNo
2011-08-01This submission is the final filingNo
2011-08-01This return/report is a short plan year return/report (less than 12 months)No
2011-08-01Plan is a collectively bargained planNo
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2009: TRAVEL ACCIDENT PLAN 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Submission has been amendedNo
2009-08-01This submission is the final filingNo
2009-08-01This return/report is a short plan year return/report (less than 12 months)No
2009-08-01Plan is a collectively bargained planNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSR043949
Policy instance 1
Insurance contract or identification numberSR043949
Number of Individuals Covered7448
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
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
Other welfare benefits providedGROUP TRAVEL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSR043949
Policy instance 1
Insurance contract or identification numberSR043949
Number of Individuals Covered7371
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
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
Other welfare benefits providedGROUP TRAVEL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSR 043949
Policy instance 1
Insurance contract or identification numberSR 043949
Number of Individuals Covered7750
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
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
Other welfare benefits providedGROUP TRAVEL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSR 043949
Policy instance 1
Insurance contract or identification numberSR 043949
Number of Individuals Covered7850
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
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
Other welfare benefits providedGROUP TRAVEL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSR 043949
Policy instance 1
Insurance contract or identification numberSR 043949
Number of Individuals Covered8200
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Other welfare benefits providedGROUP TRAVEL ACCIDENT
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberSR 043949
Policy instance 1
Insurance contract or identification numberSR 043949
Number of Individuals Covered8000
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Other welfare benefits providedGROUP TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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