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KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 401k Plan overview

Plan NameKOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN
Plan identification number 502

KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

KOELSCH SENIOR COMMUNITIES has sponsored the creation of one or more 401k plans.

Company Name:KOELSCH SENIOR COMMUNITIES
Employer identification number (EIN):421676216
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-09-01COLIN BOSSIO2023-03-01
5022020-09-01DENNIS CHRISTIANSON2022-04-15
5022019-09-01JERAME JOHNSON2021-03-15
5022018-09-01TIFFANY AKIN2020-03-04
5022017-09-01
5022016-09-01TIFFANY AKIN TIFFANY AKIN2018-02-16
5022015-09-01TIFFANY AKIN TIFFANY AKIN2017-03-15
5022014-09-01NANCY MORMAN NANCY MORMAN2016-03-25
5022013-09-01NANCY MORMAN NANCY MORMAN2015-03-19
5022012-09-01ELLEN SHARBONO ELLEN SHARBONO2014-02-25
5022011-09-01ELLEN SHARBONO ELLEN SHARBONO2012-12-27
5022009-09-01DENNIS CHRISTIANSON DENNIS CHRISTIANSON2011-03-18

Plan Statistics for KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN

401k plan membership statisitcs for KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN

Measure Date Value
2021: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01131
Total number of active participants reported on line 7a of the Form 55002021-09-01121
Number of retired or separated participants receiving benefits2021-09-013
Number of other retired or separated participants entitled to future benefits2021-09-010
Total of all active and inactive participants2021-09-01124
Number of employers contributing to the scheme2021-09-010
2020: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01502
Total number of active participants reported on line 7a of the Form 55002020-09-01485
Number of retired or separated participants receiving benefits2020-09-017
Number of other retired or separated participants entitled to future benefits2020-09-010
Total of all active and inactive participants2020-09-01492
Number of employers contributing to the scheme2020-09-010
2019: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01332
Total number of active participants reported on line 7a of the Form 55002019-09-01349
Number of retired or separated participants receiving benefits2019-09-014
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-01353
Number of employers contributing to the scheme2019-09-010
2018: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01112
Total number of active participants reported on line 7a of the Form 55002018-09-01112
Number of retired or separated participants receiving benefits2018-09-010
Number of other retired or separated participants entitled to future benefits2018-09-010
Total of all active and inactive participants2018-09-01112
Number of employers contributing to the scheme2018-09-010
2017: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01207
Total number of active participants reported on line 7a of the Form 55002017-09-01112
Number of retired or separated participants receiving benefits2017-09-010
Number of other retired or separated participants entitled to future benefits2017-09-010
Total of all active and inactive participants2017-09-01112
Number of employers contributing to the scheme2017-09-010
2016: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01193
Total number of active participants reported on line 7a of the Form 55002016-09-01206
Number of retired or separated participants receiving benefits2016-09-011
Number of other retired or separated participants entitled to future benefits2016-09-010
Total of all active and inactive participants2016-09-01207
2015: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01152
Total number of active participants reported on line 7a of the Form 55002015-09-01192
Number of retired or separated participants receiving benefits2015-09-010
Number of other retired or separated participants entitled to future benefits2015-09-010
Total of all active and inactive participants2015-09-01192
2014: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01204
Total number of active participants reported on line 7a of the Form 55002014-09-01258
Number of retired or separated participants receiving benefits2014-09-011
Number of other retired or separated participants entitled to future benefits2014-09-010
Total of all active and inactive participants2014-09-01259
2013: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01104
Total number of active participants reported on line 7a of the Form 55002013-09-01203
Number of retired or separated participants receiving benefits2013-09-011
Number of other retired or separated participants entitled to future benefits2013-09-010
Total of all active and inactive participants2013-09-01204
2012: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-01104
Total number of active participants reported on line 7a of the Form 55002012-09-01104
Number of retired or separated participants receiving benefits2012-09-010
Number of other retired or separated participants entitled to future benefits2012-09-010
Total of all active and inactive participants2012-09-01104
2011: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01113
Total number of active participants reported on line 7a of the Form 55002011-09-01100
Number of retired or separated participants receiving benefits2011-09-014
Number of other retired or separated participants entitled to future benefits2011-09-010
Total of all active and inactive participants2011-09-01104
2009: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01122
Total number of active participants reported on line 7a of the Form 55002009-09-01109
Number of retired or separated participants receiving benefits2009-09-013
Number of other retired or separated participants entitled to future benefits2009-09-010
Total of all active and inactive participants2009-09-01112
Total participants2009-09-010

Form 5500 Responses for KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN

2021: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan funding arrangement – General assets of the sponsorYes
2021-09-01Plan benefit arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – General assets of the sponsorYes
2020: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan funding arrangement – General assets of the sponsorYes
2020-09-01Plan benefit arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – General assets of the sponsorYes
2019: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan funding arrangement – General assets of the sponsorYes
2019-09-01Plan benefit arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – General assets of the sponsorYes
2018: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan funding arrangement – General assets of the sponsorYes
2018-09-01Plan benefit arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – General assets of the sponsorYes
2017: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan funding arrangement – General assets of the sponsorYes
2017-09-01Plan benefit arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – General assets of the sponsorYes
2016: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Submission has been amendedNo
2014-09-01This submission is the final filingNo
2014-09-01This return/report is a short plan year return/report (less than 12 months)No
2014-09-01Plan is a collectively bargained planNo
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Submission has been amendedNo
2013-09-01This submission is the final filingNo
2013-09-01This return/report is a short plan year return/report (less than 12 months)No
2013-09-01Plan is a collectively bargained planNo
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Submission has been amendedNo
2012-09-01This submission is the final filingNo
2012-09-01This return/report is a short plan year return/report (less than 12 months)No
2012-09-01Plan is a collectively bargained planNo
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Submission has been amendedNo
2011-09-01This submission is the final filingNo
2011-09-01This return/report is a short plan year return/report (less than 12 months)No
2011-09-01Plan is a collectively bargained planNo
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes
2009: KOELSCH SENIOR COMMUNITIES GROUP HEALTH PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01First time form 5500 has been submittedYes
2009-09-01Submission has been amendedNo
2009-09-01This submission is the final filingNo
2009-09-01This return/report is a short plan year return/report (less than 12 months)No
2009-09-01Plan is a collectively bargained planNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered121
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $22,837
Total amount of fees paid to insurance companyUSD $427
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $750,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,837
Amount paid for insurance broker fees427
Additional information about fees paid to insurance brokerRETENTION BONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered123
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $20,386
Total amount of fees paid to insurance companyUSD $644
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $696,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,386
Amount paid for insurance broker fees644
Additional information about fees paid to insurance brokerRETENTION BONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered129
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $21,144
Total amount of fees paid to insurance companyUSD $4,676
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $732,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,144
Amount paid for insurance broker fees4676
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered116
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $18,476
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $604,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,476
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered112
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $18,272
Total amount of fees paid to insurance companyUSD $1
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $600,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number4000030
Policy instance 2
Insurance contract or identification number4000030
Number of Individuals Covered191
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $37,778
Total amount of fees paid to insurance companyUSD $6,690
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,259,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,778
Amount paid for insurance broker fees1876
Additional information about fees paid to insurance brokerPREFERRED PRODUCER PROGRAM
Insurance broker organization code?3
Insurance broker nameBRATRUD MIDDLETON INSURANCE BROKERS
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered113
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $17,059
Total amount of fees paid to insurance companyUSD $321
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $565,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,059
Amount paid for insurance broker fees321
Additional information about fees paid to insurance brokerBONUS AMOUNT
Insurance broker organization code?3
Insurance broker namePROPEL INSURANCE
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number4000030
Policy instance 2
Insurance contract or identification number4000030
Number of Individuals Covered151
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $32,686
Total amount of fees paid to insurance companyUSD $6,364
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,091,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,686
Amount paid for insurance broker fees3111
Additional information about fees paid to insurance brokerPREFERRED PRODUCER PROGRAM
Insurance broker organization code?3
Insurance broker nameBRATRUD MIDDLETON INSURANCE BROKERS
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered120
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $17,924
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $603,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,924
Insurance broker organization code?3
Insurance broker namePROPEL INSURANCE
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number4000030
Policy instance 2
Insurance contract or identification number4000030
Number of Individuals Covered98
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $23,767
Total amount of fees paid to insurance companyUSD $2,420
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $792,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,767
Amount paid for insurance broker fees1223
Additional information about fees paid to insurance brokerPREFERRED PRODUCER PROGRAM
Insurance broker organization code?3
Insurance broker nameBRATRUD MIDDLETON INSURANCE BROKERS
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered113
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $17,606
Total amount of fees paid to insurance companyUSD $397
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $628,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,606
Amount paid for insurance broker fees397
Additional information about fees paid to insurance brokerFEES AND OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker namePROPEL INSURANCE
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered104
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $30,486
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $632,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,486
Insurance broker organization code?3
Insurance broker namePROPEL INSURANCE
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered114
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $26,997
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $529,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16507
Policy instance 1
Insurance contract or identification number16507
Number of Individuals Covered128
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $34,747
Total amount of fees paid to insurance companyUSD $497
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $716,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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