401k Plan data: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS plan

WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 401k Plan overview

Plan Name	WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS
Plan identification number	501

WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

WEST RIVER HEALTH SERVICES has sponsored the creation of one or more 401k plans.

Company Name: WEST RIVER HEALTH SERVICES

Employer identification number (EIN): 450340688

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 NATHAN STADHEIM 2024-09-26
501 2022-01-01 NATHAN STADHEIM 2023-06-26
501 2021-01-01 NATHAN STADHEIM 2022-04-11
501 2020-01-01 NATHAN STADHEIM 2021-07-28
501 2019-01-01 NATHAN STADHEIM 2020-07-06
501 2017-01-01
501 2014-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Date Sponsor Signed
501	2023-01-01	NATHAN STADHEIM	2024-09-26
501	2022-01-01	NATHAN STADHEIM	2023-06-26
501	2021-01-01	NATHAN STADHEIM	2022-04-11
501	2020-01-01	NATHAN STADHEIM	2021-07-28
501	2019-01-01	NATHAN STADHEIM		2020-07-06
501	2017-01-01
501	2014-01-01

Plan Statistics for WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS

401k plan membership statisitcs for WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS

Measure Date Value
2023: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2023 401k membership
Total participants, beginning-of-year 2023-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 113
Number of retired or separated participants receiving benefits 2023-01-01 3
Total of all active and inactive participants 2023-01-01 116
2022: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2022 401k membership
Total participants, beginning-of-year 2022-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 127
Number of retired or separated participants receiving benefits 2022-01-01 3
Total of all active and inactive participants 2022-01-01 130
2021: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2021 401k membership
Total participants, beginning-of-year 2021-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 149
Number of retired or separated participants receiving benefits 2021-01-01 3
Total of all active and inactive participants 2021-01-01 152
2020: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2020 401k membership
Total participants, beginning-of-year 2020-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 152
Number of retired or separated participants receiving benefits 2020-01-01 1
Total of all active and inactive participants 2020-01-01 153
2019: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2019 401k membership
Total participants, beginning-of-year 2019-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 194
Number of retired or separated participants receiving benefits 2019-01-01 3
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 197
2017: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2017 401k membership
Total participants, beginning-of-year 2017-01-01 224
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 225
Number of retired or separated participants receiving benefits 2017-01-01 3
Total of all active and inactive participants 2017-01-01 228
2014: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2014 401k membership
Total participants, beginning-of-year 2014-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 206
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 206

Measure	Date	Value
2023: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2023 401k membership
Total participants, beginning-of-year	2023-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	113
Number of retired or separated participants receiving benefits	2023-01-01	3
Total of all active and inactive participants	2023-01-01	116
2022: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2022 401k membership
Total participants, beginning-of-year	2022-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	127
Number of retired or separated participants receiving benefits	2022-01-01	3
Total of all active and inactive participants	2022-01-01	130
2021: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2021 401k membership
Total participants, beginning-of-year	2021-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	149
Number of retired or separated participants receiving benefits	2021-01-01	3
Total of all active and inactive participants	2021-01-01	152
2020: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2020 401k membership
Total participants, beginning-of-year	2020-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	152
Number of retired or separated participants receiving benefits	2020-01-01	1
Total of all active and inactive participants	2020-01-01	153
2019: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2019 401k membership
Total participants, beginning-of-year	2019-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	194
Number of retired or separated participants receiving benefits	2019-01-01	3
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	197
2017: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2017 401k membership
Total participants, beginning-of-year	2017-01-01	224
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	225
Number of retired or separated participants receiving benefits	2017-01-01	3
Total of all active and inactive participants	2017-01-01	228
2014: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2014 401k membership
Total participants, beginning-of-year	2014-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	206
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	206

Form 5500 Responses for WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS

2023: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2017: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2014: WEST RIVER HEALTH SERVICES HEALTH, VISION AND DENTAL BENEFITS 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

9872

Policy instance

Insurance contract or identification number	9872
Number of Individuals Covered	217
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $9,340
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $93,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

VNX NDTDD551752

Policy instance

Insurance contract or identification number	VNX NDTDD551752
Number of Individuals Covered	27
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,091
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

VNW NDTDD551751

Policy instance

Insurance contract or identification number	VNW NDTDD551751
Number of Individuals Covered	185
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $12,052
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )

Policy contract number

250955

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

VNW NDTDD551751

Policy instance

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )

Policy contract number

250955

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

VNW NDTDD551751

Policy instance

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )

Policy contract number

250955

Policy instance

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )

Policy contract number

250955

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

VNW NDTDD551751

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

VNW NDTDD551751

Policy instance

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )

Policy contract number

78427

Policy instance

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )

Policy contract number

78427

Policy instance

SANFORD HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95683 )

Policy contract number

HP040051

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

VNW NDTDD551751

Policy instance

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Company Name:	WEST RIVER HEALTH SERVICES
Employer identification number (EIN):	450340688
NAIC Classification:	622000
NAIC Description:	Hospitals