PRAIRIE BAND POTAWATOMI NATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN
| Measure | Date | Value |
|---|
| 2020: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 617 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 666 |
| Total of all active and inactive participants | 2020-01-01 | 666 |
| Total participants | 2020-01-01 | 666 |
| 2018: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 621 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 617 |
| Total of all active and inactive participants | 2018-05-01 | 617 |
| 2017: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 656 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 621 |
| Total of all active and inactive participants | 2017-05-01 | 621 |
| 2016: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 649 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 656 |
| Total of all active and inactive participants | 2016-05-01 | 656 |
| 2015: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 664 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 649 |
| Total of all active and inactive participants | 2015-05-01 | 649 |
| 2014: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 664 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 413 |
| Total of all active and inactive participants | 2014-05-01 | 413 |
| 2013: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 571 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 664 |
| Total of all active and inactive participants | 2013-05-01 | 664 |
| 2012: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 534 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 571 |
| Total of all active and inactive participants | 2012-05-01 | 571 |
| 2011: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 502 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 534 |
| Total of all active and inactive participants | 2011-05-01 | 534 |
| 2010: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-05-01 | 522 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-05-01 | 502 |
| Total of all active and inactive participants | 2010-05-01 | 502 |
| 2009: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 468 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 522 |
| Total of all active and inactive participants | 2009-05-01 | 522 |
| Total participants | 2009-05-01 | 522 |
| 2020: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | Plan funding arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | Plan funding arrangement – Insurance | Yes |
| 2016-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2010 form 5500 responses |
|---|
| 2010-05-01 | Type of plan entity | Single employer plan |
| 2010-05-01 | Plan funding arrangement – Insurance | Yes |
| 2010-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: PRAIRIE BAND POTAWATOMI NATION HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | Submission has been amended | No |
| 2009-05-01 | This submission is the final filing | No |
| 2009-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-05-01 | Plan is a collectively bargained plan | No |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30044707 |
| Policy instance | 4 |
| Insurance contract or identification number | 30044707 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,061 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $41,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,468 | | Amount paid for insurance broker fees | 2061 | | Additional information about fees paid to insurance broker | BROKER FEE. | | Insurance broker organization code? | 2 |
|
| ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 ) |
| Policy contract number | 00027150 |
| Policy instance | 3 |
| Insurance contract or identification number | 00027150 | | Number of Individuals Covered | 454 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $194,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 50935 |
| Policy instance | 2 |
| Insurance contract or identification number | 50935 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $222,658 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
| Policy contract number | 07606 |
| Policy instance | 1 |
| Insurance contract or identification number | 07606 | | Number of Individuals Covered | 666 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 51794 |
| Policy instance | 3 |
| Insurance contract or identification number | 51794 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,661 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,661 | | Insurance broker organization code? | 3 |
|
| ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 ) |
| Policy contract number | 00027150 |
| Policy instance | 2 |
| Insurance contract or identification number | 00027150 | | Number of Individuals Covered | 461 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $186,749 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
| Policy contract number | 07606 |
| Policy instance | 1 |
| Insurance contract or identification number | 07606 | | Number of Individuals Covered | 617 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
| Policy contract number | 51794 |
| Policy instance | 3 |
| Insurance contract or identification number | 51794 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,661 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 ) |
| Policy contract number | 00027150 |
| Policy instance | 2 |
| Insurance contract or identification number | 00027150 | | Number of Individuals Covered | 461 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $186,749 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
| Policy contract number | 0905802 |
| Policy instance | 1 |
| Insurance contract or identification number | 0905802 | | Number of Individuals Covered | 621 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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