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WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 401k Plan overview

Plan NameWEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN
Plan identification number 506

WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN Benefits

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

401k Sponsoring company profile

WEST SIDE COMMUNITY HEALTH SERVICES has sponsored the creation of one or more 401k plans.

Company Name:WEST SIDE COMMUNITY HEALTH SERVICES
Employer identification number (EIN):237156236
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062021-01-01CHRISTIE JANSEN2022-07-19
5062020-01-01
5062019-01-01
5062018-01-01BLAKE DARSOW
5062017-01-01BLAKE DARSOW
5062016-01-01BLAKE DARSOW
5062015-01-01BLAKE DARSOW
5062014-01-01BLAKE DARSOW
5062013-01-01BLAKE DARSOW
5062012-01-01BLAKE DARSOW
5062011-01-01BLAKE DARSOW
5062010-01-01BLAKE DARSOW
5062009-01-01BLAKE DARSOW
5062008-01-01BLAKE DARSOW
5062007-01-01BLAKE DARSOW
5062006-01-01BLAKE DARSOW
5062005-01-01BLAKE DARSOW
5062004-01-01BLAKE DARSOW
5062003-01-01BLAKE DARSOW

Plan Statistics for WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN

401k plan membership statisitcs for WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN

Measure Date Value
2021: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01254
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
Number of employers contributing to the scheme2021-01-010
2020: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01271
Total number of active participants reported on line 7a of the Form 55002020-01-01254
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01254
2019: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01275
Total number of active participants reported on line 7a of the Form 55002019-01-01271
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01271
2018: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01248
Total number of active participants reported on line 7a of the Form 55002018-01-01275
Total of all active and inactive participants2018-01-01275
Total participants2018-01-01275
2017: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01226
Total number of active participants reported on line 7a of the Form 55002017-01-01248
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01248
Total participants2017-01-01248
2016: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01196
Total number of active participants reported on line 7a of the Form 55002016-01-01226
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01226
2015: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01178
Total number of active participants reported on line 7a of the Form 55002015-01-01196
Total of all active and inactive participants2015-01-01196
2014: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01163
Total number of active participants reported on line 7a of the Form 55002014-01-01178
Total of all active and inactive participants2014-01-01178
2013: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01170
Total number of active participants reported on line 7a of the Form 55002013-01-01163
Total of all active and inactive participants2013-01-01163
2012: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01184
Total number of active participants reported on line 7a of the Form 55002012-01-01170
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01170
2011: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01179
Total number of active participants reported on line 7a of the Form 55002011-01-01184
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01184
2010: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01179
Total number of active participants reported on line 7a of the Form 55002010-01-01179
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01179
2009: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01179
Total number of active participants reported on line 7a of the Form 55002009-01-01179
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01179
2008: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01179
Total number of active participants reported on line 7a of the Form 55002008-01-01179
Number of retired or separated participants receiving benefits2008-01-010
Number of other retired or separated participants entitled to future benefits2008-01-010
Total of all active and inactive participants2008-01-01179
2007: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01179
Total number of active participants reported on line 7a of the Form 55002007-01-01179
Number of retired or separated participants receiving benefits2007-01-010
Number of other retired or separated participants entitled to future benefits2007-01-010
Total of all active and inactive participants2007-01-01179
2006: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01179
Total number of active participants reported on line 7a of the Form 55002006-01-01179
Number of retired or separated participants receiving benefits2006-01-010
Number of other retired or separated participants entitled to future benefits2006-01-010
Total of all active and inactive participants2006-01-01179
2005: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2005 401k membership
Total participants, beginning-of-year2005-01-01179
Total number of active participants reported on line 7a of the Form 55002005-01-01179
Number of retired or separated participants receiving benefits2005-01-010
Number of other retired or separated participants entitled to future benefits2005-01-010
Total of all active and inactive participants2005-01-01179
2004: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2004 401k membership
Total participants, beginning-of-year2004-01-01179
Total number of active participants reported on line 7a of the Form 55002004-01-01179
Number of retired or separated participants receiving benefits2004-01-010
Number of other retired or separated participants entitled to future benefits2004-01-010
Total of all active and inactive participants2004-01-01179
2003: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2003 401k membership
Total participants, beginning-of-year2003-01-01179
Total number of active participants reported on line 7a of the Form 55002003-01-01179
Number of retired or separated participants receiving benefits2003-01-010
Number of other retired or separated participants entitled to future benefits2003-01-010
Total of all active and inactive participants2003-01-01179

Form 5500 Responses for WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN

2021: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01This submission is the final filingYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes
2008: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – General assets of the sponsorYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – General assets of the sponsorYes
2007: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan funding arrangement – General assets of the sponsorYes
2007-01-01Plan benefit arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – General assets of the sponsorYes
2006: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01Submission has been amendedNo
2006-01-01This submission is the final filingNo
2006-01-01This return/report is a short plan year return/report (less than 12 months)No
2006-01-01Plan is a collectively bargained planNo
2006-01-01Plan funding arrangement – InsuranceYes
2006-01-01Plan funding arrangement – General assets of the sponsorYes
2006-01-01Plan benefit arrangement – InsuranceYes
2006-01-01Plan benefit arrangement – General assets of the sponsorYes
2005: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2005 form 5500 responses
2005-01-01Type of plan entitySingle employer plan
2005-01-01Submission has been amendedNo
2005-01-01This submission is the final filingNo
2005-01-01This return/report is a short plan year return/report (less than 12 months)No
2005-01-01Plan is a collectively bargained planNo
2005-01-01Plan funding arrangement – InsuranceYes
2005-01-01Plan funding arrangement – General assets of the sponsorYes
2005-01-01Plan benefit arrangement – InsuranceYes
2005-01-01Plan benefit arrangement – General assets of the sponsorYes
2004: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01Submission has been amendedNo
2004-01-01This submission is the final filingNo
2004-01-01This return/report is a short plan year return/report (less than 12 months)No
2004-01-01Plan is a collectively bargained planNo
2004-01-01Plan funding arrangement – InsuranceYes
2004-01-01Plan funding arrangement – General assets of the sponsorYes
2004-01-01Plan benefit arrangement – InsuranceYes
2004-01-01Plan benefit arrangement – General assets of the sponsorYes
2003: WEST SIDE COMMUNITY HEALTH SERVICES HEALTHCARE & DEP DAYCARE EXP REIMB PLAN 2003 form 5500 responses
2003-01-01Type of plan entitySingle employer plan
2003-01-01Submission has been amendedNo
2003-01-01This submission is the final filingNo
2003-01-01This return/report is a short plan year return/report (less than 12 months)No
2003-01-01Plan is a collectively bargained planNo
2003-01-01Plan funding arrangement – InsuranceYes
2003-01-01Plan funding arrangement – General assets of the sponsorYes
2003-01-01Plan benefit arrangement – InsuranceYes
2003-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )
Policy contract number308586
Policy instance 1
Insurance contract or identification number308586
Number of Individuals Covered626
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $40,581
Total amount of fees paid to insurance companyUSD $4,603
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,705,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,581
Amount paid for insurance broker fees4603
Additional information about fees paid to insurance brokerBROKER INCENTIVE PROGRAM
Insurance broker organization code?3
MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )
Policy contract number308586
Policy instance 1
Insurance contract or identification number308586
Number of Individuals Covered629
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $40,912
Total amount of fees paid to insurance companyUSD $6,234
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,727,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number20230
Policy instance 1
Insurance contract or identification number20230
Number of Individuals Covered275
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,615,672
Commission paid to Insurance BrokerUSD $52,431
Amount paid for insurance broker fees177
Additional information about fees paid to insurance brokerHARP BONUS PROGRAM
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number20230
Policy instance 1
Insurance contract or identification number20230
Number of Individuals Covered248
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,758,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $76,687
Amount paid for insurance broker fees155
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
Insurance broker organization code?3
Insurance broker nameASSOCIATED BENEFITS & RISK CONSULT

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