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SCAN INC CAFETERIA PLAN SEC 125 401k Plan overview

Plan NameSCAN INC CAFETERIA PLAN SEC 125
Plan identification number 501

SCAN INC CAFETERIA PLAN SEC 125 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)

401k Sponsoring company profile

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

Company Name:SCAN, INC.
Employer identification number (EIN):310899309
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SCAN INC CAFETERIA PLAN SEC 125

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012024-01-01KEITH LAWSON
5012023-01-01
5012023-01-01DEANNA SZYNDROWSKI
5012022-01-01
5012022-01-01DEANNA SZYNDROWSKI
5012021-01-01
5012021-01-01NICKOLAUS CRIPE
5012020-01-01
5012019-01-01
5012014-01-01JEFFREY GRIGGS JEFFREY GRIGGS2019-06-24
5012013-01-01JEFFREY GRIGGS JEFFREY GRIGGS2019-06-24
5012012-01-01JEFFREY GRIGGS JEFFREY GRIGGS2019-06-24
5012011-01-01RACHEL TOBIN-SMITH
5012009-01-01RACHEL TOBIN-SMITH
5012008-01-01RACHEL TOBIN-SMITH
5012007-01-01RACHEL TOBIN-SMITH

Plan Statistics for SCAN INC CAFETERIA PLAN SEC 125

401k plan membership statisitcs for SCAN INC CAFETERIA PLAN SEC 125

Measure Date Value
2023: SCAN INC CAFETERIA PLAN SEC 125 2023 401k membership
Total participants, beginning-of-year2023-01-01129
Total number of active participants reported on line 7a of the Form 55002023-01-01124
Total of all active and inactive participants2023-01-01124
Total participants2023-01-01124
2022: SCAN INC CAFETERIA PLAN SEC 125 2022 401k membership
Total participants, beginning-of-year2022-01-01152
Total number of active participants reported on line 7a of the Form 55002022-01-01129
Total of all active and inactive participants2022-01-01129
Total participants2022-01-01129
2021: SCAN INC CAFETERIA PLAN SEC 125 2021 401k membership
Total participants, beginning-of-year2021-01-01138
Total number of active participants reported on line 7a of the Form 55002021-01-01152
Total of all active and inactive participants2021-01-01152
Total participants2021-01-01152
2020: SCAN INC CAFETERIA PLAN SEC 125 2020 401k membership
Total participants, beginning-of-year2020-01-01166
Total number of active participants reported on line 7a of the Form 55002020-01-01138
Total of all active and inactive participants2020-01-01138
Total participants2020-01-01138
2019: SCAN INC CAFETERIA PLAN SEC 125 2019 401k membership
Total participants, beginning-of-year2019-01-01181
Total number of active participants reported on line 7a of the Form 55002019-01-01166
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 participants2019-01-01166
Total participants2019-01-01166
2014: SCAN INC CAFETERIA PLAN SEC 125 2014 401k membership
Total participants, beginning-of-year2014-01-01120
Total number of active participants reported on line 7a of the Form 55002014-01-01150
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01150
2013: SCAN INC CAFETERIA PLAN SEC 125 2013 401k membership
Total participants, beginning-of-year2013-01-01114
Total number of active participants reported on line 7a of the Form 55002013-01-01120
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01120
2012: SCAN INC CAFETERIA PLAN SEC 125 2012 401k membership
Total participants, beginning-of-year2012-01-0189
Total number of active participants reported on line 7a of the Form 55002012-01-01114
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 participants2012-01-01114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01114
2011: SCAN INC CAFETERIA PLAN SEC 125 2011 401k membership
Total participants, beginning-of-year2011-01-0189
Total of all active and inactive participants2011-01-010
Total participants2011-01-010
2009: SCAN INC CAFETERIA PLAN SEC 125 2009 401k membership
Total participants, beginning-of-year2009-01-0181
Total number of active participants reported on line 7a of the Form 55002009-01-0182
Number of retired or separated participants receiving benefits2009-01-012
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0184
Total participants2009-01-0184
Number of participants with account balances2009-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010
Number of employers contributing to the scheme2009-01-010
2008: SCAN INC CAFETERIA PLAN SEC 125 2008 401k membership
Total participants, beginning-of-year2008-01-0184
Total number of active participants reported on line 7a of the Form 55002008-01-0179
Number of retired or separated participants receiving benefits2008-01-012
Number of other retired or separated participants entitled to future benefits2008-01-010
Total of all active and inactive participants2008-01-0181
Total participants2008-01-0181
Number of participants with account balances2008-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2008-01-010
Number of employers contributing to the scheme2008-01-010
2007: SCAN INC CAFETERIA PLAN SEC 125 2007 401k membership
Total participants, beginning-of-year2007-01-0184
Total number of active participants reported on line 7a of the Form 55002007-01-0184
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 participants2007-01-0184
Total participants2007-01-0184
Number of participants with account balances2007-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2007-01-010
Number of employers contributing to the scheme2007-01-010

Financial Data on SCAN INC CAFETERIA PLAN SEC 125

Measure Date Value
2024 : SCAN INC CAFETERIA PLAN SEC 125 2024 401k financial data
Total unrealized appreciation/depreciation of assets2024-01-01$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2024-01-01$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2024-01-01$0
Total income from all sources (including contributions)2024-01-01$1,368,271
Total loss/gain on sale of assets2024-01-01$0
Total of all expenses incurred2024-01-01$1,368,271
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2024-01-01$1,368,271
Total contributions o plan (from employers,participants, others, non cash contrinutions)2024-01-01$1,368,271
Value of total assets at end of year2024-01-01$0
Value of total assets at beginning of year2024-01-01$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2024-01-01$0
Total interest from all sources2024-01-01$0
Total dividends received (eg from common stock, registered investment company shares)2024-01-01$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2024-01-01No
Was this plan covered by a fidelity bond2024-01-01Yes
Value of fidelity bond cover2024-01-01$1,000,000
If this is an individual account plan, was there a blackout period2024-01-01No
Were there any nonexempt tranactions with any party-in-interest2024-01-01No
Contributions received from participants2024-01-01$239,369
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2024-01-01No
Value of net income/loss2024-01-01$0
Value of net assets at end of year (total assets less liabilities)2024-01-01$0
Value of net assets at beginning of year (total assets less liabilities)2024-01-01$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2024-01-01No
Were any loans by the plan or fixed income obligations due to the plan in default2024-01-01No
Were any leases to which the plan was party in default or uncollectible2024-01-01No
Expenses. Payments to insurance carriers foe the provision of benefits2024-01-01$1,368,271
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2024-01-01No
Was there a failure to transmit to the plan any participant contributions2024-01-01No
Has the plan failed to provide any benefit when due under the plan2024-01-01No
Contributions received in cash from employer2024-01-01$1,128,902
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32024-01-01No
Did the plan have assets held for investment2024-01-01No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2024-01-01No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2024-01-01No
2023 : SCAN INC CAFETERIA PLAN SEC 125 2023 401k financial data
Total unrealized appreciation/depreciation of assets2023-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total income from all sources (including contributions)2023-12-31$1,094,094
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$1,094,094
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$1,094,094
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$1,094,094
Value of total assets at end of year2023-12-31$0
Value of total assets at beginning of year2023-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$0
Total interest from all sources2023-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$1,000,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$176,507
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Value of net income/loss2023-12-31$0
Value of net assets at end of year (total assets less liabilities)2023-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2023-12-31$1,094,094
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$917,587
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32023-12-31No
Did the plan have assets held for investment2023-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Total unrealized appreciation/depreciation of assets2023-01-01$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-01-01$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-01-01$0
Total income from all sources (including contributions)2023-01-01$1,094,094
Total loss/gain on sale of assets2023-01-01$0
Total of all expenses incurred2023-01-01$1,094,094
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-01-01$1,094,094
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-01-01$1,094,094
Value of total assets at end of year2023-01-01$0
Value of total assets at beginning of year2023-01-01$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-01-01$0
Total interest from all sources2023-01-01$0
Total dividends received (eg from common stock, registered investment company shares)2023-01-01$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-01-01No
Was this plan covered by a fidelity bond2023-01-01Yes
Value of fidelity bond cover2023-01-01$1,000,000
If this is an individual account plan, was there a blackout period2023-01-01No
Were there any nonexempt tranactions with any party-in-interest2023-01-01No
Contributions received from participants2023-01-01$176,507
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-01-01No
Value of net income/loss2023-01-01$0
Value of net assets at end of year (total assets less liabilities)2023-01-01$0
Value of net assets at beginning of year (total assets less liabilities)2023-01-01$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-01-01No
Were any loans by the plan or fixed income obligations due to the plan in default2023-01-01No
Were any leases to which the plan was party in default or uncollectible2023-01-01No
Expenses. Payments to insurance carriers foe the provision of benefits2023-01-01$1,094,094
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-01-01No
Was there a failure to transmit to the plan any participant contributions2023-01-01No
Has the plan failed to provide any benefit when due under the plan2023-01-01No
Contributions received in cash from employer2023-01-01$917,587
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32023-01-01No
Did the plan have assets held for investment2023-01-01No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-01-01No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-01-01No
2021 : SCAN INC CAFETERIA PLAN SEC 125 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$978,827
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$978,827
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$978,827
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$978,827
Value of total assets at end of year2021-12-31$0
Value of total assets at beginning of year2021-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$0
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$188,257
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$0
Value of net assets at end of year (total assets less liabilities)2021-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$978,827
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$790,570
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
2019 : SCAN INC CAFETERIA PLAN SEC 125 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$965,242
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$965,242
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$965,242
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$965,242
Value of total assets at end of year2019-12-31$0
Value of total assets at beginning of year2019-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$0
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$204,076
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$0
Value of net assets at end of year (total assets less liabilities)2019-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$965,242
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$761,166
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
2018 : SCAN INC CAFETERIA PLAN SEC 125 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$1,104,514
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,104,514
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,104,514
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,104,514
Value of total assets at end of year2018-12-31$0
Value of total assets at beginning of year2018-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$0
Total interest from all sources2018-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$191,318
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$0
Value of net assets at end of year (total assets less liabilities)2018-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$1,104,514
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$913,196
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
2017 : SCAN INC CAFETERIA PLAN SEC 125 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$1,379,850
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,379,850
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,379,850
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,379,850
Value of total assets at end of year2017-12-31$0
Value of total assets at beginning of year2017-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$0
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$202,981
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$0
Value of net assets at end of year (total assets less liabilities)2017-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$1,379,850
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$1,176,869
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
2016 : SCAN INC CAFETERIA PLAN SEC 125 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$1,387,935
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$1,387,935
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,387,935
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,387,935
Value of total assets at end of year2016-12-31$0
Value of total assets at beginning of year2016-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$0
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$207,369
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$0
Value of net assets at end of year (total assets less liabilities)2016-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$1,387,935
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,180,566
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
2014 : SCAN INC CAFETERIA PLAN SEC 125 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$1,028,292
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$1,028,292
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,028,292
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,028,292
Value of total assets at end of year2014-12-31$0
Value of total assets at beginning of year2014-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$0
Total interest from all sources2014-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$171,449
Total non interest bearing cash at end of year2014-12-31$0
Total non interest bearing cash at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$0
Value of net assets at end of year (total assets less liabilities)2014-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$1,028,292
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$856,843
Liabilities. Value of benefit claims payable at end of year2014-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$0
Did the plan have assets held for investment2014-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
2013 : SCAN INC CAFETERIA PLAN SEC 125 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$799,217
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$799,217
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$799,217
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$799,217
Value of total assets at end of year2013-12-31$0
Value of total assets at beginning of year2013-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$0
Total interest from all sources2013-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Was this plan covered by a fidelity bond2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$164,895
Total non interest bearing cash at end of year2013-12-31$0
Total non interest bearing cash at beginning of year2013-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$0
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$799,217
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$634,322
Liabilities. Value of benefit claims payable at end of year2013-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$0
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
2012 : SCAN INC CAFETERIA PLAN SEC 125 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$674,374
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$674,374
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$674,374
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$674,374
Value of total assets at end of year2012-12-31$0
Value of total assets at beginning of year2012-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$0
Total interest from all sources2012-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Assets. Corporate prefeered stocks other than exployer securities at end of year2012-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2012-12-31$0
Was this plan covered by a fidelity bond2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$156,875
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$0
Value of net assets at end of year (total assets less liabilities)2012-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$674,374
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$517,499
Liabilities. Value of benefit claims payable at end of year2012-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$0
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
2011 : SCAN INC CAFETERIA PLAN SEC 125 2011 401k financial data
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$36,721
Total plan assets at end of year2011-12-31$0
Total plan assets at beginning of year2011-12-31$0
Value of fidelity bond covering the plan2011-12-31$250,000
Total contributions received or receivable from participants2011-12-31$36,721
Net income (gross income less expenses)2011-12-31$36,721
2010 : SCAN INC CAFETERIA PLAN SEC 125 2010 401k financial data
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$125,017
Total plan assets at beginning of year2010-12-31$0
Value of fidelity bond covering the plan2010-12-31$100,000
Total contributions received or receivable from participants2010-12-31$125,017
Net income (gross income less expenses)2010-12-31$125,017

Form 5500 Responses for SCAN INC CAFETERIA PLAN SEC 125

2023: SCAN INC CAFETERIA PLAN SEC 125 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: SCAN INC CAFETERIA PLAN SEC 125 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: SCAN INC CAFETERIA PLAN SEC 125 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: SCAN INC CAFETERIA PLAN SEC 125 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 benefit arrangement – InsuranceYes
2019: SCAN INC CAFETERIA PLAN SEC 125 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 benefit arrangement – InsuranceYes
2014: SCAN INC CAFETERIA PLAN SEC 125 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
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 benefit arrangement – InsuranceYes
2013: SCAN INC CAFETERIA PLAN SEC 125 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
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 benefit arrangement – InsuranceYes
2012: SCAN INC CAFETERIA PLAN SEC 125 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
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 benefit arrangement – InsuranceYes
2011: SCAN INC CAFETERIA PLAN SEC 125 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: SCAN INC CAFETERIA PLAN SEC 125 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: SCAN INC CAFETERIA PLAN SEC 125 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: SCAN INC CAFETERIA PLAN SEC 125 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberW11789;00250309
Policy instance 3
Insurance contract or identification numberW11789;00250309
Number of Individuals Covered124
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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 BenefitNo
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $3,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA (National Association of Insurance Commissioners NAIC id number: 95436 )
Policy contract number1564
Policy instance 2
Insurance contract or identification number1564
Number of Individuals Covered84
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $32,423
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 $1,001,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BT8L
Policy instance 1
Insurance contract or identification numberG000BT8L
Number of Individuals Covered124
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $10,361
Total amount of fees paid to insurance companyUSD $2,615
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
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 $88,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BT8L
Policy instance 3
Insurance contract or identification numberG000BT8L
Number of Individuals Covered129
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $953
Total amount of fees paid to insurance companyUSD $268
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 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
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 $9,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberW11789;00250309
Policy instance 2
Insurance contract or identification numberW11789;00250309
Number of Individuals Covered129
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 BenefitNo
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
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA (National Association of Insurance Commissioners NAIC id number: 95436 )
Policy contract number1564
Policy instance 1
Insurance contract or identification number1564
Number of Individuals Covered88
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $18,887
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 $1,202,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BT8L
Policy instance 3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberW11789;00250309
Policy instance 2
PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA (National Association of Insurance Commissioners NAIC id number: 95436 )
Policy contract number1564
Policy instance 1
PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA (National Association of Insurance Commissioners NAIC id number: 95436 )
Policy contract number1564
Policy instance 2
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW11789;00250309
Policy instance 1
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW11789;00250309
Policy instance 1
PHYSICIANS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberC35201
Policy instance 1

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