401k Plan data: INTERMED, P.A. HEALTH & WELFARE PLAN plan

INTERMED, P.A. HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	INTERMED, P.A. HEALTH & WELFARE PLAN
Plan identification number	504

INTERMED, P.A. HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Other welfare benefit cover

401k Sponsoring company profile

INTERMED, P.A. has sponsored the creation of one or more 401k plans.

Company Name: INTERMED, P.A.

Employer identification number (EIN): 010484903

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INTERMED, P.A. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-01-01 WILLIAM FERENTZ 2023-07-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2022-01-01	WILLIAM FERENTZ	2023-07-27

Plan Statistics for INTERMED, P.A. HEALTH & WELFARE PLAN

401k plan membership statisitcs for INTERMED, P.A. HEALTH & WELFARE PLAN

Measure Date Value
2022: INTERMED, P.A. HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 527
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 551
Number of retired or separated participants receiving benefits 2022-01-01 5
Total of all active and inactive participants 2022-01-01 556

Measure	Date	Value
2022: INTERMED, P.A. HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	527
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	551
Number of retired or separated participants receiving benefits	2022-01-01	5
Total of all active and inactive participants	2022-01-01	556

Form 5500 Responses for INTERMED, P.A. HEALTH & WELFARE PLAN

2022: INTERMED, P.A. HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

ANTHEM HEALTH PLANS OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 52618 )

Policy contract number

00Y068

Policy instance

Insurance contract or identification number	00Y068
Number of Individuals Covered	855
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $40,275
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,404,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,275
Insurance broker organization code?	3

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )

Policy contract number

705824

Policy instance

Insurance contract or identification number	705824
Number of Individuals Covered	65
Insurance policy start date	2022-09-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $284
Total amount of fees paid to insurance company	USD $28
Other welfare benefits provided	ATTAINED AGE CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $1,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $284
Amount paid for insurance broker fees	28
Insurance broker organization code?	3

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )

Policy contract number

705823

Policy instance

Insurance contract or identification number	705823
Number of Individuals Covered	61
Insurance policy start date	2022-09-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GRP ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )

Policy contract number

705822

Policy instance

Insurance contract or identification number	705822
Number of Individuals Covered	33
Insurance policy start date	2022-09-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL EE PAID
Welfare Benefit Premiums Paid to Carrier	USD $2,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	INTERMED, P.A.
Employer identification number (EIN):	010484903
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)