401k Plan data: NORTHLAKES COMMUNITY CLINIC plan

NORTHLAKES COMMUNITY CLINIC 401k Plan overview

Plan Name	NORTHLAKES COMMUNITY CLINIC
Plan identification number	631

NORTHLAKES COMMUNITY CLINIC Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness)

401k Sponsoring company profile

THE LAKES COMMUNITY HEALTH CENTER, INC has sponsored the creation of one or more 401k plans.

Company Name: THE LAKES COMMUNITY HEALTH CENTER, INC

Employer identification number (EIN): 352297925

NAIC Classification: 621498
NAIC Description: All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHLAKES COMMUNITY CLINIC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
631 2021-01-01
631 2020-01-01

Plan Statistics for NORTHLAKES COMMUNITY CLINIC

401k plan membership statisitcs for NORTHLAKES COMMUNITY CLINIC

Measure Date Value
2021: NORTHLAKES COMMUNITY CLINIC 2021 401k membership
Total participants, beginning-of-year 2021-01-01 287
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 320
Total of all active and inactive participants 2021-01-01 320
Total participants 2021-01-01 320
2020: NORTHLAKES COMMUNITY CLINIC 2020 401k membership
Total participants, beginning-of-year 2020-01-01 322
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 287
Total of all active and inactive participants 2020-01-01 287
Total participants 2020-01-01 287

Measure	Date	Value
2021: NORTHLAKES COMMUNITY CLINIC 2021 401k membership
Total participants, beginning-of-year	2021-01-01	287
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	320
Total of all active and inactive participants	2021-01-01	320
Total participants	2021-01-01	320
2020: NORTHLAKES COMMUNITY CLINIC 2020 401k membership
Total participants, beginning-of-year	2020-01-01	322
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	287
Total of all active and inactive participants	2020-01-01	287
Total participants	2020-01-01	287

Form 5500 Responses for NORTHLAKES COMMUNITY CLINIC

2021: NORTHLAKES COMMUNITY CLINIC 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: NORTHLAKES COMMUNITY CLINIC 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

702862

Policy instance

Insurance contract or identification number	702862
Number of Individuals Covered	320
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,115
Total amount of fees paid to insurance company	USD $8,604
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $1,291
Amount paid for insurance broker fees	619
Insurance broker organization code?	3

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

702862

Policy instance

Insurance contract or identification number	702862
Number of Individuals Covered	287
Total amount of commissions paid to insurance broker	USD $5,151
Total amount of fees paid to insurance company	USD $1,208
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $730
Amount paid for insurance broker fees	88
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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Company Name:	THE LAKES COMMUNITY HEALTH CENTER, INC
Employer identification number (EIN):	352297925
NAIC Classification:	621498
NAIC Description:	All Other Outpatient Care Centers