401k Plan data: INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN plan

INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN 401k Plan overview

Plan Name	INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN
Plan identification number	502

INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. has sponsored the creation of one or more 401k plans.

Company Name: INDIAN RIVER COUNTY MEDICAL SOCIETY, INC.

Employer identification number (EIN): 651150062

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-03-01 JENNIFER JONES 2022-11-07
502 2020-03-01 CHARLES ROBINSON 2021-12-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-03-01	JENNIFER JONES	2022-11-07
502	2020-03-01	CHARLES ROBINSON	2021-12-09

Plan Statistics for INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN

401k plan membership statisitcs for INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN

Measure Date Value
2021: INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-03-01 93
Total number of active participants reported on line 7a of the Form 5500 2021-03-01 87
Number of retired or separated participants receiving benefits 2021-03-01 0
Number of other retired or separated participants entitled to future benefits 2021-03-01 0
Total of all active and inactive participants 2021-03-01 87
Number of employers contributing to the scheme 2021-03-01 0
2020: INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-03-01 93
Total number of active participants reported on line 7a of the Form 5500 2020-03-01 93
Number of retired or separated participants receiving benefits 2020-03-01 0
Number of other retired or separated participants entitled to future benefits 2020-03-01 0
Total of all active and inactive participants 2020-03-01 93
Number of employers contributing to the scheme 2020-03-01 0

Measure	Date	Value
2021: INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-03-01	93
Total number of active participants reported on line 7a of the Form 5500	2021-03-01	87
Number of retired or separated participants receiving benefits	2021-03-01	0
Number of other retired or separated participants entitled to future benefits	2021-03-01	0
Total of all active and inactive participants	2021-03-01	87
Number of employers contributing to the scheme	2021-03-01	0
2020: INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-03-01	93
Total number of active participants reported on line 7a of the Form 5500	2020-03-01	93
Number of retired or separated participants receiving benefits	2020-03-01	0
Number of other retired or separated participants entitled to future benefits	2020-03-01	0
Total of all active and inactive participants	2020-03-01	93
Number of employers contributing to the scheme	2020-03-01	0

Form 5500 Responses for INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN

2021: INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2021 form 5500 responses
2021-03-01	Type of plan entity	Mulitple employer plan
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes
2020: INDIAN RIVER COUNTY MEDICAL SOCIETY, INC. EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2020 form 5500 responses
2020-03-01	Type of plan entity	Mulitple employer plan
2020-03-01	First time form 5500 has been submitted	Yes
2020-03-01	Plan funding arrangement – Insurance	Yes
2020-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

954790

Policy instance

Insurance contract or identification number	954790
Number of Individuals Covered	72
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $7,787
Total amount of fees paid to insurance company	USD $39
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,193
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

954791

Policy instance

Insurance contract or identification number	954791
Number of Individuals Covered	87
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $5,896
Total amount of fees paid to insurance company	USD $52
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $28,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,543
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

954790

Policy instance

Insurance contract or identification number	954790
Number of Individuals Covered	66
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $7,485
Total amount of fees paid to insurance company	USD $1,996
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,990
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

954791

Policy instance

Insurance contract or identification number	954791
Number of Individuals Covered	93
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $5,661
Total amount of fees paid to insurance company	USD $1,008
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $30,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,401
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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Company Name:	INDIAN RIVER COUNTY MEDICAL SOCIETY, INC.
Employer identification number (EIN):	651150062
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)