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GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 401k Plan overview

Plan NameGREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN
Plan identification number 506

GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

GREEN BAY ONCOLOGY, LTD. has sponsored the creation of one or more 401k plans.

Company Name:GREEN BAY ONCOLOGY, LTD.
Employer identification number (EIN):391314853
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062014-01-01GINA MOON GINA MOON2015-07-29
5062013-01-01DAVID L GROTELUSCHEN DAVID L. GROTELUSCHEN2014-07-08
5062012-05-01DAVID L. GROTELUSCHEN
5062011-05-01PETER G. SAFRANSKI PETER G. SAFRANSKI2012-11-07
5062009-05-01PETER G. SAFRANSKI PETER G. SAFRANSKI2010-10-18

Plan Statistics for GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN

401k plan membership statisitcs for GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN

Measure Date Value
2014: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01149
Total number of active participants reported on line 7a of the Form 55002014-01-01129
Total of all active and inactive participants2014-01-01129
2013: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01158
Total number of active participants reported on line 7a of the Form 55002013-01-01149
Total of all active and inactive participants2013-01-01149
2012: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01152
Total number of active participants reported on line 7a of the Form 55002012-05-01158
Total of all active and inactive participants2012-05-01158
2011: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01142
Total number of active participants reported on line 7a of the Form 55002011-05-01152
Total of all active and inactive participants2011-05-01152
2009: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-010
Total number of active participants reported on line 7a of the Form 55002009-05-01123
Total of all active and inactive participants2009-05-01123

Form 5500 Responses for GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN

2014: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2009: GREEN BAY ONCOLOGY, LTD GROUP LIFE, LONG- TERM DISABILITY, AND AD&D INSURANCE PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01First time form 5500 has been submittedYes
2009-05-01This submission is the final filingNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberLIF94049
Policy instance 1
Insurance contract or identification numberLIF94049
Number of Individuals Covered129
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $911
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $911
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberLTD94049
Policy instance 2
Insurance contract or identification numberLTD94049
Number of Individuals Covered128
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,265
Total amount of fees paid to insurance companyUSD $180
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,265
Insurance broker organization code?3
Amount paid for insurance broker fees180
Additional information about fees paid to insurance brokerFEES
Insurance broker nameMEDICAL GROUP INSURANCE SERVICES, I
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberLIF94049
Policy instance 1
Insurance contract or identification numberLIF94049
Number of Individuals Covered149
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,278
Total amount of fees paid to insurance companyUSD $225
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,278
Amount paid for insurance broker fees225
Additional information about fees paid to insurance brokerADMINISTRATIVE FEE
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberLTD94049
Policy instance 2
Insurance contract or identification numberLTD94049
Number of Individuals Covered148
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $13,862
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,862
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5431085
Policy instance 1
Insurance contract or identification number5431085
Number of Individuals Covered153
Insurance policy start date2012-05-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $3,491
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $27,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,491
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberLIF94049
Policy instance 2
Insurance contract or identification numberLIF94049
Number of Individuals Covered158
Insurance policy start date2012-09-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberLTD94049
Policy instance 3
Insurance contract or identification numberLTD94049
Number of Individuals Covered155
Insurance policy start date2012-09-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5431085
Policy instance 1
Insurance contract or identification number5431085
Number of Individuals Covered152
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $5,557
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $73,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5431085
Policy instance 1
Insurance contract or identification number5431085
Number of Individuals Covered142
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $5,391
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $63,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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