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MAIN STREET RURAL HEALTH BENEFIT PLAN 401k Plan overview

Plan NameMAIN STREET RURAL HEALTH BENEFIT PLAN
Plan identification number 501

MAIN STREET RURAL HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • 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

MAIN STREET RURAL HEALTH, LLC has sponsored the creation of one or more 401k plans.

Company Name:MAIN STREET RURAL HEALTH, LLC
Employer identification number (EIN):870917282

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAIN STREET RURAL HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01BRANDON KERNS2024-02-20

Plan Statistics for MAIN STREET RURAL HEALTH BENEFIT PLAN

401k plan membership statisitcs for MAIN STREET RURAL HEALTH BENEFIT PLAN

Measure Date Value
2022: MAIN STREET RURAL HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-0186
Total number of active participants reported on line 7a of the Form 55002022-07-01412
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01412
Number of employers contributing to the scheme2022-07-010

Form 5500 Responses for MAIN STREET RURAL HEALTH BENEFIT PLAN

2022: MAIN STREET RURAL HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-07-01Type of plan entityMulitple employer plan
2022-07-01First time form 5500 has been submittedYes
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number145493
Policy instance 1
Insurance contract or identification number145493
Number of Individuals Covered579
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $86,245
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,245
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number37921
Policy instance 2
Insurance contract or identification number37921
Number of Individuals Covered719
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $58,727
Total amount of fees paid to insurance companyUSD $2,127
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $285,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,722
Amount paid for insurance broker fees2127
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3

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