401k Plan data: MAYFIELD CLINIC, INC. HEALTH AND WELFARE BENEFITPLAN plan

MAYFIELD CLINIC, INC. HEALTH AND WELFARE BENEFITPLAN 401k Plan overview

Plan Name	MAYFIELD CLINIC, INC. HEALTH AND WELFARE BENEFITPLAN
Plan identification number	501

MAYFIELD CLINIC, INC. HEALTH AND WELFARE BENEFITPLAN Benefits

401k Plan Type	Welfare 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

MAYFIELD CLINIC, INC. has sponsored the creation of one or more 401k plans.

Company Name: MAYFIELD CLINIC, INC.

Employer identification number (EIN): 310588183

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

Additional information about MAYFIELD CLINIC, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1970-06-24

Company Identification Number: 399028

Legal Registered Office Address: 425 WALNUT ST #1800
-
CINCINNATI
United States of America (USA)
452020000

More information about MAYFIELD CLINIC, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAYFIELD CLINIC, INC. HEALTH AND WELFARE BENEFITPLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 LORI GULLEY 2024-06-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	LORI GULLEY	2024-06-11

Form 5500 Responses for MAYFIELD CLINIC, INC. HEALTH AND WELFARE BENEFITPLAN

2023: MAYFIELD CLINIC, INC. HEALTH AND WELFARE BENEFITPLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SOK0608525

Policy instance

Insurance contract or identification number	SOK0608525
Number of Individuals Covered	166
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,155
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $142,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

SUPERIOR DENTAL CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96280 )

Policy contract number

D9350, D9325

Policy instance

Insurance contract or identification number	D9350, D9325
Number of Individuals Covered	187
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,434
Total amount of fees paid to insurance company	USD $2,677
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10198011001

Policy instance

Insurance contract or identification number	10198011001
Number of Individuals Covered	390
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,113
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MAYFIELD CLINIC, INC.
Employer identification number (EIN):	310588183
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1970-06-24
Company Identification Number:	399028
Legal Registered Office Address:	425 WALNUT ST #1800 - CINCINNATI United States of America (USA) 452020000