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THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN 401k Plan overview

Plan NameTHE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN
Plan identification number 514

THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA 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)

401k Sponsoring company profile

BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON, INDIANA INC., DBA KING has sponsored the creation of one or more 401k plans.

Company Name:BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON, INDIANA INC., DBA KING
Employer identification number (EIN):350895832
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5142022-01-01JOHN PRICE2023-03-28
5142021-01-01JOHN PRICE2022-05-05
5142020-01-01JOHN PRICE2021-06-10

Plan Statistics for THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN

401k plan membership statisitcs for THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN

Measure Date Value
2022: THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01741
Total number of active participants reported on line 7a of the Form 55002022-01-01674
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01674
Number of employers contributing to the scheme2022-01-010
2021: THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01772
Total number of active participants reported on line 7a of the Form 55002021-01-01741
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 participants2021-01-01741
Number of employers contributing to the scheme2021-01-010
2020: THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01764
Total number of active participants reported on line 7a of the Form 55002020-01-01772
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 participants2020-01-01772
Number of employers contributing to the scheme2020-01-010

Form 5500 Responses for THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN

2022: THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number505487
Policy instance 4
Insurance contract or identification number505487
Number of Individuals Covered1045
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,132
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $6,132
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number71335-0
Policy instance 3
Insurance contract or identification number71335-0
Number of Individuals Covered371
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $27,928
Total amount of fees paid to insurance companyUSD $4,163
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $130,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,182
Amount paid for insurance broker fees3927
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00617677
Policy instance 2
Insurance contract or identification numberG00617677
Number of Individuals Covered674
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $37,456
Total amount of fees paid to insurance companyUSD $22,993
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 $355,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $37,456
Amount paid for insurance broker fees971
Additional information about fees paid to insurance brokerOTHEER COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number683
Policy instance 1
Insurance contract or identification number683
Number of Individuals Covered1178
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,756
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 $6,756
Amount paid for insurance broker fees0
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number505487
Policy instance 4
Insurance contract or identification number505487
Number of Individuals Covered1180
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,427
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $6,427
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number71335-0
Policy instance 3
Insurance contract or identification number71335-0
Number of Individuals Covered555
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $34,229
Total amount of fees paid to insurance companyUSD $4,319
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $139,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,957
Amount paid for insurance broker fees4194
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00617677
Policy instance 2
Insurance contract or identification numberG00617677
Number of Individuals Covered741
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $38,873
Total amount of fees paid to insurance companyUSD $36,471
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 $368,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $38,873
Amount paid for insurance broker fees12521
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number683
Policy instance 1
Insurance contract or identification number683
Number of Individuals Covered1339
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,763
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 $6,763
Amount paid for insurance broker fees0
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number505487
Policy instance 4
Insurance contract or identification number505487
Number of Individuals Covered1236
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,258
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,258
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number71335-0
Policy instance 3
Insurance contract or identification number71335-0
Number of Individuals Covered641
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $32,042
Total amount of fees paid to insurance companyUSD $4,806
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $160,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,042
Amount paid for insurance broker fees4806
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00617677
Policy instance 2
Insurance contract or identification numberG00617677
Number of Individuals Covered773
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $37,391
Total amount of fees paid to insurance companyUSD $61,291
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 $355,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $37,391
Amount paid for insurance broker fees37073
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number683
Policy instance 1
Insurance contract or identification number683
Number of Individuals Covered1417
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,455
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 $7,455
Amount paid for insurance broker fees0
Insurance broker organization code?3

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