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OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameOHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 503

OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare 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)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

THE OHIO EASTERN STAR HOME has sponsored the creation of one or more 401k plans.

Company Name:THE OHIO EASTERN STAR HOME
Employer identification number (EIN):314405826
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about THE OHIO EASTERN STAR HOME

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1951-10-01
Company Identification Number: 224851
Legal Registered Office Address: 10 S GAY STREET
PO BOX 469
MOUNT VERNON
United States of America (USA)
43050

More information about THE OHIO EASTERN STAR HOME

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032021-07-01MICHELE ENGELBACH2022-11-01
5032020-07-01MICHELLE GARCIA2021-12-29

Plan Statistics for OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2021: OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01105
Total number of active participants reported on line 7a of the Form 55002021-07-0187
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-0187
Number of employers contributing to the scheme2021-07-010
2020: OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01115
Total number of active participants reported on line 7a of the Form 55002020-07-01105
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01105
Number of employers contributing to the scheme2020-07-010

Form 5500 Responses for OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN

2021: OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: OHIO EASTERN STAR HOME HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01First time form 5500 has been submittedYes
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number575389
Policy instance 6
Insurance contract or identification number575389
Number of Individuals Covered12
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $3,565
Total amount of fees paid to insurance companyUSD $1,195
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $16,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,565
Amount paid for insurance broker fees1195
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
TELEMEDICINE MANAGEMENT, INC. DBA SWIFTMD (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number1026
Policy instance 5
Insurance contract or identification number1026
Number of Individuals Covered87
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00616772
Policy instance 4
Insurance contract or identification numberG00616772
Number of Individuals Covered87
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $5,755
Total amount of fees paid to insurance companyUSD $1,299
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $36,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $5,755
Amount paid for insurance broker fees1299
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10158771001
Policy instance 3
Insurance contract or identification number10158771001
Number of Individuals Covered90
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $1,431
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,431
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )
Policy contract number981
Policy instance 2
Insurance contract or identification number981
Number of Individuals Covered82
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,486
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,486
Amount paid for insurance broker fees0
Insurance broker organization code?3
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberW50110
Policy instance 1
Insurance contract or identification numberW50110
Number of Individuals Covered63
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $24,300
Total amount of fees paid to insurance companyUSD $11,867
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $677,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,625
Amount paid for insurance broker fees702
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
TELEMEDICINE MANAGEMENT, INC. DBA SWIFTMD (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number1026
Policy instance 5
Insurance contract or identification number1026
Number of Individuals Covered105
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00616772
Policy instance 4
Insurance contract or identification numberG00616772
Number of Individuals Covered105
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $4,444
Total amount of fees paid to insurance companyUSD $427
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $31,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $4,444
Amount paid for insurance broker fees427
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10158771001
Policy instance 3
Insurance contract or identification number10158771001
Number of Individuals Covered113
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $1,743
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,743
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )
Policy contract number981
Policy instance 2
Insurance contract or identification number981
Number of Individuals Covered98
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,815
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,815
Amount paid for insurance broker fees0
Insurance broker organization code?3
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberW50110
Policy instance 1
Insurance contract or identification numberW50110
Number of Individuals Covered102
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $27,828
Total amount of fees paid to insurance companyUSD $12,368
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $724,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,055
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES

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