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ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 401k Plan overview

Plan NameANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER
Plan identification number 505

ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER Benefits

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

401k Sponsoring company profile

ANDREW J. WILL, MD, PA DBA TWIN CITIES PAIN CLINIC has sponsored the creation of one or more 401k plans.

Company Name:ANDREW J. WILL, MD, PA DBA TWIN CITIES PAIN CLINIC
Employer identification number (EIN):870692497
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-01-01TAMMY RASSIER2023-06-21
5052021-01-01EMILY VANBUREN2022-03-09
5052020-01-01EMILY VANBUREN2021-03-30
5052019-01-01EMILY VANBUREN2020-06-10

Plan Statistics for ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER

401k plan membership statisitcs for ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER

Measure Date Value
2022: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2022 401k membership
Total participants, beginning-of-year2022-01-01117
Total number of active participants reported on line 7a of the Form 55002022-01-01135
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01135
Number of employers contributing to the scheme2022-01-010
2021: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2021 401k membership
Total participants, beginning-of-year2021-01-01107
Total number of active participants reported on line 7a of the Form 55002021-01-01117
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01117
Number of employers contributing to the scheme2021-01-010
2020: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2020 401k membership
Total participants, beginning-of-year2020-01-01119
Total number of active participants reported on line 7a of the Form 55002020-01-01107
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01107
Number of employers contributing to the scheme2020-01-010
2019: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2019 401k membership
Total participants, beginning-of-year2019-01-01107
Total number of active participants reported on line 7a of the Form 55002019-01-01119
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01119
Number of employers contributing to the scheme2019-01-010

Form 5500 Responses for ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER

2022: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01First time form 5500 has been submittedYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number421787
Policy instance 1
Insurance contract or identification number421787
Number of Individuals Covered135
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $23,584
Total amount of fees paid to insurance companyUSD $6,652
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $181,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,142
Amount paid for insurance broker fees4385
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number421787
Policy instance 1
Insurance contract or identification number421787
Number of Individuals Covered117
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $26,214
Total amount of fees paid to insurance companyUSD $6,553
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $201,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,164
Amount paid for insurance broker fees4033
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number421787
Policy instance 1
Insurance contract or identification number421787
Number of Individuals Covered107
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $15,959
Total amount of fees paid to insurance companyUSD $3,780
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $118,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,873
Amount paid for insurance broker fees2078
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number421787
Policy instance 1
Insurance contract or identification number421787
Number of Individuals Covered119
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $15,157
Total amount of fees paid to insurance companyUSD $2,652
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $151,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,157
Amount paid for insurance broker fees2652
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3

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