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| Plan Name | HEARTLAND COMMUNITY HEALTH CENTER BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | HEARTLAND MEDICAL CLINIC INC |
| Employer identification number (EIN): | 481221800 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2022: HEARTLAND COMMUNITY HEALTH CENTER BENEFITS PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 172 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 173 |
| 2022: HEARTLAND COMMUNITY HEALTH CENTER BENEFITS PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | First time form 5500 has been submitted | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 810585427 | ||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 5390117 | ||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 101615365141343 | ||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||
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