401k Plan data: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN plan

HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 401k Plan overview

Plan Name	HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN
Plan identification number	504

HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Vision

401k Sponsoring company profile

HEARTLAND FINANCIAL USA, INC. has sponsored the creation of one or more 401k plans.

Company Name: HEARTLAND FINANCIAL USA, INC.

Employer identification number (EIN): 421405748

NAIC Classification: 522110
NAIC Description: Commercial Banking

Additional information about HEARTLAND FINANCIAL USA, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2018-05-14

Company Identification Number: 0803019875

Legal Registered Office Address: 700 LOCUST ST STE 400

DUBUQUE
United States of America (USA)
52001

More information about HEARTLAND FINANCIAL USA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2013-01-01 JAN MCGARRY JAN MCGARRY 2014-09-09
504 2013-01-01 JONI DRAKE JONI DRAKE 2019-06-18
504 2012-01-01 JAN MCGARRY
504 2011-01-01 JAN MCGARRY
504 2010-01-01 NANCY M WILSON, SR VP HR
504 2009-01-01 NANCY M WILSON, SR VP HR

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2013-01-01	JAN MCGARRY	JAN MCGARRY	2014-09-09
504	2013-01-01	JONI DRAKE	JONI DRAKE	2019-06-18
504	2012-01-01	JAN MCGARRY
504	2011-01-01	JAN MCGARRY
504	2010-01-01	NANCY M WILSON, SR VP HR
504	2009-01-01	NANCY M WILSON, SR VP HR

Plan Statistics for HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN

401k plan membership statisitcs for HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN

Measure Date Value
2013: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 158
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 160
2012: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 141
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 143
2011: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 139
Number of retired or separated participants receiving benefits 2011-01-01 2
Total of all active and inactive participants 2011-01-01 141
2010: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 123
Number of retired or separated participants receiving benefits 2010-01-01 4
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
2009: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 119
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 120

Measure	Date	Value
2013: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	158
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	160
2012: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	141
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	143
2011: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	139
Number of retired or separated participants receiving benefits	2011-01-01	2
Total of all active and inactive participants	2011-01-01	141
2010: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	123
Number of retired or separated participants receiving benefits	2010-01-01	4
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
2009: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	119
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	120

Form 5500 Responses for HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN

2013: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: HEARTLAND FINANCIAL USA, INC. HMO MEDICAL PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MEDICAL ASSOCIATES HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 52559 )

Policy contract number

0262220001

Policy instance

Insurance contract or identification number	0262220001
Number of Individuals Covered	390
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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 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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
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
Welfare Benefit Premiums Paid to Carrier	USD $1,574,864

Potentially related plans

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Company Name:	HEARTLAND FINANCIAL USA, INC.
Employer identification number (EIN):	421405748
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2018-05-14
Company Identification Number:	0803019875
Legal Registered Office Address:	700 LOCUST ST STE 400 DUBUQUE United States of America (USA) 52001