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GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameGREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN
Plan identification number 501

GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

GREAT BASIN INSTITUTE has sponsored the creation of one or more 401k plans.

Company Name:GREAT BASIN INSTITUTE
Employer identification number (EIN):880431016
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-12-01KEVIN DOSE2024-03-13
5012021-12-01KEVIN DOSE2023-05-30
5012021-12-01KEVIN DOSE2024-03-20
5012020-12-01KEVIN DOSE2022-02-16
5012019-12-01KEVIN DOSE2021-06-22
5012018-12-01

Plan Statistics for GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN

401k plan membership statisitcs for GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN

Measure Date Value
2022: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-12-01176
Total number of active participants reported on line 7a of the Form 55002022-12-01248
Number of retired or separated participants receiving benefits2022-12-010
Number of other retired or separated participants entitled to future benefits2022-12-010
Total of all active and inactive participants2022-12-01248
Number of employers contributing to the scheme2022-12-010
2021: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01199
Total number of active participants reported on line 7a of the Form 55002021-12-01176
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01176
Number of employers contributing to the scheme2021-12-010
2020: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01198
Total number of active participants reported on line 7a of the Form 55002020-12-01199
Number of retired or separated participants receiving benefits2020-12-010
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-01199
Number of employers contributing to the scheme2020-12-010
2019: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01197
Total number of active participants reported on line 7a of the Form 55002019-12-01197
Number of retired or separated participants receiving benefits2019-12-011
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-01198
Number of employers contributing to the scheme2019-12-010
2018: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01121
Total number of active participants reported on line 7a of the Form 55002018-12-01197
Number of retired or separated participants receiving benefits2018-12-010
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-01197

Form 5500 Responses for GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN

2022: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-12-01Type of plan entitySingle employer plan
2022-12-01Plan funding arrangement – InsuranceYes
2022-12-01Plan benefit arrangement – InsuranceYes
2021: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedYes
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – InsuranceYes
2020: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan benefit arrangement – InsuranceYes
2019: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan benefit arrangement – InsuranceYes
2018: GREAT BASIN INSTITUTE HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01First time form 5500 has been submittedYes
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1150956
Policy instance 2
Insurance contract or identification number1150956
Number of Individuals Covered265
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,297
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,297
Amount paid for insurance broker fees0
Insurance broker organization code?3
SAINT MARYS HEALTHFIRST (National Association of Insurance Commissioners NAIC id number: 11079 )
Policy contract numberGRP0003430
Policy instance 1
Insurance contract or identification numberGRP0003430
Number of Individuals Covered255
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $47,163
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,022,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,163
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-049262
Policy instance 2
Insurance contract or identification number010-049262
Number of Individuals Covered413
Insurance policy start date2021-12-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $11,532
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $115,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,532
Amount paid for insurance broker fees0
Insurance broker organization code?3
SAINT MARYS HEALTHFIRST (National Association of Insurance Commissioners NAIC id number: 11079 )
Policy contract numberGRP0003430
Policy instance 1
Insurance contract or identification numberGRP0003430
Number of Individuals Covered262
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $51,123
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,019,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,123
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-049262
Policy instance 2
Insurance contract or identification number010-049262
Number of Individuals Covered468
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $11,272
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,272
Amount paid for insurance broker fees0
Insurance broker organization code?3
SAINT MARYS HEALTHFIRST (National Association of Insurance Commissioners NAIC id number: 11079 )
Policy contract numberGRP0003430
Policy instance 1
Insurance contract or identification numberGRP0003430
Number of Individuals Covered233
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $42,276
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $845,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,276
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1671
Policy instance 3
Insurance contract or identification number1671
Number of Individuals Covered61
Insurance policy start date2019-12-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,241
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 $15,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,241
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-049262
Policy instance 2
Insurance contract or identification number010-049262
Number of Individuals Covered433
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $11,418
Total amount of fees paid to insurance companyUSD $651
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,418
Amount paid for insurance broker fees651
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
SAINT MARYS HEALTHFIRST (National Association of Insurance Commissioners NAIC id number: 11079 )
Policy contract numberGRP0003430
Policy instance 1
Insurance contract or identification numberGRP0003430
Number of Individuals Covered194
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $41,071
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $821,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,071
Amount paid for insurance broker fees0
Insurance broker organization code?3
SAINT MARYS HEALTHFIRST (National Association of Insurance Commissioners NAIC id number: 11079 )
Policy contract numberGRP0003430
Policy instance 1
Insurance contract or identification numberGRP0003430
Number of Individuals Covered76
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $19,359
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $387,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,359
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1671
Policy instance 3
Insurance contract or identification number1671
Number of Individuals Covered100
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $41,083
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 $330,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,083
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-049262
Policy instance 2
Insurance contract or identification number010-049262
Number of Individuals Covered147
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $3,814
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedLASIK, HEARING
Welfare Benefit Premiums Paid to CarrierUSD $38,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,814
Insurance broker organization code?3

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