| Plan Name | ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| 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) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2023-01-01 | TAMMY RASSIER | 2024-06-25 | ||
| 505 | 2022-01-01 | TAMMY RASSIER | 2023-06-21 | ||
| 505 | 2021-01-01 | EMILY VANBUREN | 2022-03-09 | ||
| 505 | 2020-01-01 | EMILY VANBUREN | 2021-03-30 | ||
| 505 | 2019-01-01 | EMILY VANBUREN | 2020-06-10 |
| 2023: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: ANDREW J. WILL MD PA DBA TWIN CITIES PAIN CLINIC AND SURGERY CENTER 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | First time form 5500 has been submitted | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||
| Policy contract number | 421787 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||
| Policy contract number | 421787 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
| |||||||||||||||||||||||||
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||
| Policy contract number | 421787 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||
| Policy contract number | 421787 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||
| Policy contract number | 421787 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||