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GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 401k Plan overview

Plan NameGROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER
Plan identification number 507

GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Dental
  • Vision

401k Sponsoring company profile

BURNETT MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name:BURNETT MEDICAL CENTER
Employer identification number (EIN):390938661
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072022-01-01JULIE MCKENZIE2023-07-18 JULIE MCKENZIE2023-07-18
5072021-01-01JULIE MCKENZIE2022-07-15 JULIE MCKENZIE2022-07-15
5072020-01-01JULIE MCKENZIE2021-07-22 JULIE MCKENZIE2021-07-22
5072019-01-01SANDRA HINRICHS2020-07-02 SANDRA HINRICHS2020-07-02
5072018-01-01SANDRA HINRICHS2019-07-25 SANDRA HINRICHS2019-07-25
5072017-01-01
5072016-01-01
5072015-01-01
5072014-01-01
5072013-01-01
5072012-01-01SANDRA HINNICHS
5072011-01-01SANDRA HINRICHS
5072010-01-01SANDY HINRICHS

Plan Statistics for GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER

401k plan membership statisitcs for GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER

Measure Date Value
2022: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2022 401k membership
Total participants, beginning-of-year2022-01-01108
Total number of active participants reported on line 7a of the Form 55002022-01-01104
Total of all active and inactive participants2022-01-01104
Total participants2022-01-01104
2021: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2021 401k membership
Total participants, beginning-of-year2021-01-01115
Total number of active participants reported on line 7a of the Form 55002021-01-01108
Total of all active and inactive participants2021-01-01108
Total participants2021-01-01108
2020: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2020 401k membership
Total participants, beginning-of-year2020-01-01110
Total number of active participants reported on line 7a of the Form 55002020-01-01115
Total of all active and inactive participants2020-01-01115
Total participants2020-01-01115
2019: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2019 401k membership
Total participants, beginning-of-year2019-01-01127
Total number of active participants reported on line 7a of the Form 55002019-01-01110
Total of all active and inactive participants2019-01-01110
Total participants2019-01-01110
2018: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2018 401k membership
Total participants, beginning-of-year2018-01-01118
Total number of active participants reported on line 7a of the Form 55002018-01-01127
Total of all active and inactive participants2018-01-01127
Total participants2018-01-01127
2017: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2017 401k membership
Total participants, beginning-of-year2017-01-01112
Total number of active participants reported on line 7a of the Form 55002017-01-01118
Total of all active and inactive participants2017-01-01118
Total participants2017-01-01118
2016: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2016 401k membership
Total participants, beginning-of-year2016-01-01120
Total number of active participants reported on line 7a of the Form 55002016-01-01112
Total of all active and inactive participants2016-01-01112
Total participants2016-01-01112
2015: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2015 401k membership
Total participants, beginning-of-year2015-01-01110
Total number of active participants reported on line 7a of the Form 55002015-01-01120
Total of all active and inactive participants2015-01-01120
Total participants2015-01-01120
2014: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2014 401k membership
Total participants, beginning-of-year2014-01-01109
Total number of active participants reported on line 7a of the Form 55002014-01-01110
Total of all active and inactive participants2014-01-01110
Total participants2014-01-01110
2013: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2013 401k membership
Total participants, beginning-of-year2013-01-01107
Total number of active participants reported on line 7a of the Form 55002013-01-01109
Total of all active and inactive participants2013-01-01109
Total participants2013-01-01109
2012: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2012 401k membership
Total participants, beginning-of-year2012-01-01111
Total number of active participants reported on line 7a of the Form 55002012-01-01107
Total of all active and inactive participants2012-01-01107
Total participants2012-01-01107
2011: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2011 401k membership
Total participants, beginning-of-year2011-01-01111
Total number of active participants reported on line 7a of the Form 55002011-01-01111
Total of all active and inactive participants2011-01-01111
Total participants2011-01-01111
2010: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2010 401k membership
Total participants, beginning-of-year2010-01-01111
Total number of active participants reported on line 7a of the Form 55002010-01-01111
Total of all active and inactive participants2010-01-01111
Total participants2010-01-01111

Form 5500 Responses for GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER

2022: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: GROUP DENTAL INSURANCE BENEFITS FOR EMPLOYEES OF BURNETT MEDICAL CENTER 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01First time form 5500 has been submittedYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract numberDD1118
Policy instance 1
Insurance contract or identification numberDD1118
Number of Individuals Covered183
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number123088
Policy instance 1
Insurance contract or identification number123088
Number of Individuals Covered191
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number123088
Policy instance 1
Insurance contract or identification number123088
Number of Individuals Covered224
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number123088
Policy instance 1
Insurance contract or identification number123088
Number of Individuals Covered110
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $13,252
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,252
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-044461
Policy instance 1
Insurance contract or identification number010-044461
Number of Individuals Covered259
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,806
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,806
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number3615
Policy instance 1
Insurance contract or identification number3615
Number of Individuals Covered120
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,215
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 $8,215
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number51014
Policy instance 2
Insurance contract or identification number51014
Number of Individuals Covered198
Insurance policy start date2016-01-01
Insurance policy end date2016-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number51014
Policy instance 2
Insurance contract or identification number51014
Number of Individuals Covered90
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $171
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $171
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00482067
Policy instance 1
Insurance contract or identification number00482067
Number of Individuals Covered110
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $7,597
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,597
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00482067
Policy instance 1
Insurance contract or identification number00482067
Number of Individuals Covered109
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,499
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,499
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-034796
Policy instance 1
Insurance contract or identification number010-034796
Number of Individuals Covered107
Insurance policy start date2012-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,632
Total amount of fees paid to insurance companyUSD $562
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,632
Amount paid for insurance broker fees562
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-034796
Policy instance 1
Insurance contract or identification number010-034796
Number of Individuals Covered111
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,285
Total amount of fees paid to insurance companyUSD $718
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,848
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-034796
Policy instance 1
Insurance contract or identification number010-034796
Number of Individuals Covered111
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,691
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,169
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC

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