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BETHANY HOME WELFARE BENEFITS PLAN 401k Plan overview

Plan NameBETHANY HOME WELFARE BENEFITS PLAN
Plan identification number 501

BETHANY HOME WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BETHANY HOME has sponsored the creation of one or more 401k plans.

Company Name:BETHANY HOME
Employer identification number (EIN):941546850
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about BETHANY HOME

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities
Incorporation Date: 1924-06-24
Company Identification Number: 054875
Legal Registered Office Address: 2100 ASBURY RD STE 2

DUBUQUE
United States of America (USA)
52001

More information about BETHANY HOME

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BETHANY HOME WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-11-01CINDY SCHEUBLEIN2024-02-07
5012021-11-01CINDY SCHEUBLEIN2023-02-08
5012020-11-01CINDY SCHEUBLEIN2022-02-10
5012019-11-01CINDY SCHEUBLEIN2021-02-22
5012018-11-01ADAM HUTCHINS2020-03-04
5012017-11-01
5012015-11-01ADAM HUTCHINS
5012014-11-01ADAM HUTCHINS

Plan Statistics for BETHANY HOME WELFARE BENEFITS PLAN

401k plan membership statisitcs for BETHANY HOME WELFARE BENEFITS PLAN

Measure Date Value
2022: BETHANY HOME WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-11-01106
Total number of active participants reported on line 7a of the Form 55002022-11-01106
Number of retired or separated participants receiving benefits2022-11-010
Number of other retired or separated participants entitled to future benefits2022-11-010
Total of all active and inactive participants2022-11-01106
Number of employers contributing to the scheme2022-11-010
2021: BETHANY HOME WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-01106
Total number of active participants reported on line 7a of the Form 55002021-11-01106
Number of retired or separated participants receiving benefits2021-11-010
Number of other retired or separated participants entitled to future benefits2021-11-010
Total of all active and inactive participants2021-11-01106
Number of employers contributing to the scheme2021-11-010
2020: BETHANY HOME WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-01106
Total number of active participants reported on line 7a of the Form 55002020-11-01106
Number of retired or separated participants receiving benefits2020-11-010
Number of other retired or separated participants entitled to future benefits2020-11-010
Total of all active and inactive participants2020-11-01106
Number of employers contributing to the scheme2020-11-010
2019: BETHANY HOME WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01151
Total number of active participants reported on line 7a of the Form 55002019-11-01151
Number of retired or separated participants receiving benefits2019-11-010
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-01151
Number of employers contributing to the scheme2019-11-010
2018: BETHANY HOME WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01118
Total number of active participants reported on line 7a of the Form 55002018-11-0169
Number of retired or separated participants receiving benefits2018-11-011
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-0170
Number of employers contributing to the scheme2018-11-010
2017: BETHANY HOME WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01138
Total number of active participants reported on line 7a of the Form 55002017-11-01116
Number of retired or separated participants receiving benefits2017-11-012
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-01118
Number of employers contributing to the scheme2017-11-010
2015: BETHANY HOME WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01102
Total number of active participants reported on line 7a of the Form 55002015-11-0187
Number of retired or separated participants receiving benefits2015-11-011
Number of other retired or separated participants entitled to future benefits2015-11-010
Total of all active and inactive participants2015-11-0188
2014: BETHANY HOME WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01102
Total number of active participants reported on line 7a of the Form 55002014-11-01101
Number of retired or separated participants receiving benefits2014-11-011
Number of other retired or separated participants entitled to future benefits2014-11-010
Total of all active and inactive participants2014-11-01102

Form 5500 Responses for BETHANY HOME WELFARE BENEFITS PLAN

2022: BETHANY HOME WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-11-01Type of plan entitySingle employer plan
2022-11-01Plan funding arrangement – InsuranceYes
2022-11-01Plan funding arrangement – General assets of the sponsorYes
2022-11-01Plan benefit arrangement – InsuranceYes
2022-11-01Plan benefit arrangement – General assets of the sponsorYes
2021: BETHANY HOME WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – General assets of the sponsorYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – General assets of the sponsorYes
2020: BETHANY HOME WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – General assets of the sponsorYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement – General assets of the sponsorYes
2019: BETHANY HOME WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – General assets of the sponsorYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – General assets of the sponsorYes
2018: BETHANY HOME WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – General assets of the sponsorYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – General assets of the sponsorYes
2017: BETHANY HOME WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – General assets of the sponsorYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – General assets of the sponsorYes
2015: BETHANY HOME WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – General assets of the sponsorYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – General assets of the sponsorYes
2014: BETHANY HOME WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01First time form 5500 has been submittedYes
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – General assets of the sponsorYes
2014-11-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number39873
Policy instance 1
Insurance contract or identification number39873
Number of Individuals Covered63
Insurance policy start date2022-11-01
Insurance policy end date2023-10-31
Total amount of commissions paid to insurance brokerUSD $30,460
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $681,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,460
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918429
Policy instance 2
Insurance contract or identification number918429
Number of Individuals Covered20
Insurance policy start date2022-11-01
Insurance policy end date2023-10-31
Total amount of commissions paid to insurance brokerUSD $1,338
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $9,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,338
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number39873
Policy instance 1
Insurance contract or identification number39873
Number of Individuals Covered54
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $25,218
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $535,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,218
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918429
Policy instance 2
Insurance contract or identification number918429
Number of Individuals Covered29
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $1,519
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $10,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,519
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918429
Policy instance 3
Insurance contract or identification number918429
Number of Individuals Covered106
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $145
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $1,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $145
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number39873
Policy instance 1
Insurance contract or identification number39873
Number of Individuals Covered70
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $32,489
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $681,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,489
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number39873
Policy instance 1
Insurance contract or identification number39873
Number of Individuals Covered83
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $35,051
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $726,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,051
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number39873
Policy instance 1
Insurance contract or identification number39873
Number of Individuals Covered94
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $34,242
Total amount of fees paid to insurance companyUSD $1
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $622,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,242
Amount paid for insurance broker fees1
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number39873
Policy instance 1
Insurance contract or identification number39873
Number of Individuals Covered90
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $34,914
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $704,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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