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ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 401k Plan overview

Plan NameST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN
Plan identification number 502

ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

ST FRANCIS HEALTH SERVICES OF MORRIS INC. has sponsored the creation of one or more 401k plans.

Company Name:ST FRANCIS HEALTH SERVICES OF MORRIS INC.
Employer identification number (EIN):411484416
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01MARI CHAMBERS2023-08-31
5022021-01-01MARI CHAMBERS2022-11-01
5022021-01-01MARI CHAMBERS2023-08-31
5022020-01-01SHERRY WAGNER2021-10-14
5022019-01-01WILL MONCRIEF2020-12-03
5022019-01-01WILL MONCRIEF2020-10-15
5022018-10-01WILL MONCRIEF2019-10-11
5022018-10-01WILL MONCRIEF2020-12-03
5022018-10-01WILL MONCRIEF2020-10-23

Plan Statistics for ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN

401k plan membership statisitcs for ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN

Measure Date Value
2022: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01699
Total number of active participants reported on line 7a of the Form 55002022-01-01655
Number of retired or separated participants receiving benefits2022-01-015
Total of all active and inactive participants2022-01-01660
Total participants2022-01-01660
2021: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01733
Total number of active participants reported on line 7a of the Form 55002021-01-01695
Number of retired or separated participants receiving benefits2021-01-014
Total of all active and inactive participants2021-01-01699
Total participants2021-01-01699
2020: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01715
Total number of active participants reported on line 7a of the Form 55002020-01-01731
Number of retired or separated participants receiving benefits2020-01-012
Total of all active and inactive participants2020-01-01733
Total participants2020-01-01733
2019: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01679
Total number of active participants reported on line 7a of the Form 55002019-01-01713
Number of retired or separated participants receiving benefits2019-01-012
Total of all active and inactive participants2019-01-01715
Total participants2019-01-01715
2018: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01672
Total number of active participants reported on line 7a of the Form 55002018-10-01664
Number of retired or separated participants receiving benefits2018-10-0115
Total of all active and inactive participants2018-10-01679
Total participants2018-10-01679

Financial Data on ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN

Measure Date Value
2022 : ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$1,987,411
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$1,352,125
Total income from all sources (including contributions)2022-12-31$9,367,482
Total of all expenses incurred2022-12-31$8,729,185
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$8,189,081
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$9,358,944
Value of total assets at end of year2022-12-31$2,727,648
Value of total assets at beginning of year2022-12-31$1,454,065
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$540,104
Total interest from all sources2022-12-31$8,538
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$183,849
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$830,257
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$335,811
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$486,758
Administrative expenses (other) incurred2022-12-31$15
Liabilities. Value of operating payables at end of year2022-12-31$4,326
Liabilities. Value of operating payables at beginning of year2022-12-31$70,911
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$638,297
Value of net assets at end of year (total assets less liabilities)2022-12-31$740,237
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$101,940
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$2,391,837
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$967,307
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$967,307
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$8,538
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$669,479
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$8,528,687
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$7,519,602
Contract administrator fees2022-12-31$356,240
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Liabilities. Value of benefit claims payable at end of year2022-12-31$1,983,085
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$1,281,214
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31MICHAEL L ANDERSON & ASSOCIATES
Accountancy firm EIN2022-12-31411799234
2021 : ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$521,214
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,677,673
Total income from all sources (including contributions)2021-12-31$7,427,722
Total of all expenses incurred2021-12-31$7,713,367
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$7,325,780
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$7,427,619
Value of total assets at end of year2021-12-31$1,383,154
Value of total assets at beginning of year2021-12-31$2,825,258
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$387,587
Total interest from all sources2021-12-31$103
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$215,848
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$702,316
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$415,847
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$1,172,061
Administrative expenses (other) incurred2021-12-31$15
Liabilities. Value of operating payables at end of year2021-12-31$70,911
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-285,645
Value of net assets at end of year (total assets less liabilities)2021-12-31$861,940
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,147,585
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$967,307
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$1,653,197
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$1,653,197
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$103
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$794,554
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$6,725,303
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$6,531,226
Contract administrator fees2021-12-31$171,724
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$521,214
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$1,677,673
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31MICHAEL L ANDERSON & ASSOICATES
Accountancy firm EIN2021-12-31411799234
2020 : ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$1,677,673
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$1,141,879
Total income from all sources (including contributions)2020-12-31$8,000,367
Total of all expenses incurred2020-12-31$7,048,429
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$6,635,330
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$7,999,261
Value of total assets at end of year2020-12-31$2,825,258
Value of total assets at beginning of year2020-12-31$1,337,526
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$413,099
Total interest from all sources2020-12-31$1,106
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$180,686
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$816,128
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$1,172,061
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$15,756
Administrative expenses (other) incurred2020-12-31$25
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$951,938
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,147,585
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$195,647
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$1,653,197
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$1,321,770
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$1,321,770
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$1,106
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$776,924
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$7,183,133
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$5,858,406
Contract administrator fees2020-12-31$232,388
Liabilities. Value of benefit claims payable at end of year2020-12-31$1,677,673
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$1,141,879
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31MICHAEL L ANDERSON & ASSOCIATES
Accountancy firm EIN2020-12-31411799234
2019 : ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2019 401k financial data
Total transfer of assets from this plan2019-12-31$466,134
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$1,141,879
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$600,000
Total income from all sources (including contributions)2019-12-31$7,745,108
Total of all expenses incurred2019-12-31$6,735,604
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$6,306,784
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$7,737,839
Value of total assets at end of year2019-12-31$1,337,526
Value of total assets at beginning of year2019-12-31$252,277
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$428,820
Total interest from all sources2019-12-31$7,269
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$206,603
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$33,823
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$15,756
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$29,035
Administrative expenses (other) incurred2019-12-31$25
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,009,504
Value of net assets at end of year (total assets less liabilities)2019-12-31$195,647
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$-347,723
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$1,321,770
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$223,242
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$223,242
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$7,269
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$749,466
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$7,704,016
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$5,557,318
Contract administrator fees2019-12-31$222,192
Liabilities. Value of benefit claims payable at end of year2019-12-31$1,141,879
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$600,000
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31MICHAEL L ANDERSON & ASSOCIATES
Accountancy firm EIN2019-12-31411799234
2018 : ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$2,100,508
Total income from all sources (including contributions)2018-12-31$1,329,182
Total of all expenses incurred2018-12-31$3,177,413
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$3,055,099
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,328,483
Value of total assets at end of year2018-12-31$252,277
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$122,314
Total interest from all sources2018-12-31$699
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$62,177
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$29,035
Administrative expenses (other) incurred2018-12-31$105
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-1,848,231
Value of net assets at end of year (total assets less liabilities)2018-12-31$-1,848,231
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$223,242
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$699
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$159,789
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$1,328,483
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$2,895,310
Contract administrator fees2018-12-31$60,032
Liabilities. Value of benefit claims payable at end of year2018-12-31$2,100,508
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31MICHAEL L ANDERSON & ASSOCIATES
Accountancy firm EIN2018-12-31411799234

Form 5500 Responses for ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN

2022: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: ST. FRANCIS HEALTH SERVICES EMPLOYEE MEDICAL PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01First time form 5500 has been submittedYes
2018-10-01Submission has been amendedYes
2018-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-10-01Plan funding arrangement – TrustYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PREFERREDONE ADMINISTRATIVE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberPKA20427
Policy instance 1
Insurance contract or identification numberPKA20427
Number of Individuals Covered748
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $183,849
Welfare Benefit Premiums Paid to CarrierUSD $669,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $183,849
Insurance broker organization code?3
PREFERREDONE ADMINISTRATIVE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberPKA20427
Policy instance 1
Insurance contract or identification numberPKA20427
Number of Individuals Covered820
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $215,848
Welfare Benefit Premiums Paid to CarrierUSD $794,554
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $215,848
Insurance broker organization code?3
PREFERREDONE ADMINISTRATIVE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberPKA20427
Policy instance 1
Insurance contract or identification numberPKA20427
Number of Individuals Covered857
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $180,686
Welfare Benefit Premiums Paid to CarrierUSD $776,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $180,686
Insurance broker organization code?3
PREFERREDONE ADMINISTRATIVE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberPKA20427
Policy instance 1
Insurance contract or identification numberPKA20427
Number of Individuals Covered847
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $206,603
Welfare Benefit Premiums Paid to CarrierUSD $749,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $206,603
Insurance broker organization code?3
PREFERREDONE ADMINISTRATIVE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberPKA20427
Policy instance 1
Insurance contract or identification numberPKA20427
Number of Individuals Covered840
Insurance policy start date2018-10-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $62,177
Welfare Benefit Premiums Paid to CarrierUSD $159,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,177
Insurance broker organization code?3

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