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HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 401k Plan overview

Plan NameHEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN
Plan identification number 502

HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED 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

HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED has sponsored the creation of one or more 401k plans.

Company Name:HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED
Employer identification number (EIN):431930178
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-04-01JOHN VINSON JR.2023-08-15
5022021-04-01JOHN VINSON JR.2022-08-25
5022020-04-01JOHN VINSON JR.2021-09-02
5022019-04-01JOHN VINSON JR.2020-09-16
5022018-04-01KIM WEYER2019-09-10
5022017-04-01
5022016-04-01

Plan Statistics for HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN

401k plan membership statisitcs for HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN

Measure Date Value
2022: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01219
Total number of active participants reported on line 7a of the Form 55002022-04-01243
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01243
Number of employers contributing to the scheme2022-04-010
2021: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01236
Total number of active participants reported on line 7a of the Form 55002021-04-01242
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01242
Number of employers contributing to the scheme2021-04-010
2020: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01232
Total number of active participants reported on line 7a of the Form 55002020-04-01229
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-01229
Number of employers contributing to the scheme2020-04-010
2019: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01261
Total number of active participants reported on line 7a of the Form 55002019-04-01222
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01222
Number of employers contributing to the scheme2019-04-010
2018: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01248
Total number of active participants reported on line 7a of the Form 55002018-04-01222
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-0126
Total of all active and inactive participants2018-04-01248
Number of employers contributing to the scheme2018-04-010
2017: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01315
Total number of active participants reported on line 7a of the Form 55002017-04-01266
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01266
2016: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01235
Total number of active participants reported on line 7a of the Form 55002016-04-01235
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-0130
Total of all active and inactive participants2016-04-01265

Form 5500 Responses for HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN

2022: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – InsuranceYes
2021: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – InsuranceYes
2020: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – InsuranceYes
2019: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – InsuranceYes
2018: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes
2017: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: HEALTH SYSTEMS OF OKLAHOMA, LLC AND ENTITIES ATTACHED WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01First time form 5500 has been submittedYes
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BBHZ
Policy instance 3
Insurance contract or identification numberGLUG0BBHZ
Number of Individuals Covered198
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $8,461
Total amount of fees paid to insurance companyUSD $8,133
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $84,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,461
Amount paid for insurance broker fees2301
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number295116
Policy instance 2
Insurance contract or identification number295116
Number of Individuals Covered79
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $23,003
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $657,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $23,003
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1091403
Policy instance 1
Insurance contract or identification number1091403
Number of Individuals Covered196
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $5,030
Total amount of fees paid to insurance companyUSD $1,864
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,420
Amount paid for insurance broker fees433
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914239
Policy instance 2
Insurance contract or identification number914239
Number of Individuals Covered77
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $37,336
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $763,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees37336
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1091403
Policy instance 1
Insurance contract or identification number1091403
Number of Individuals Covered182
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $5,152
Total amount of fees paid to insurance companyUSD $1,174
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,152
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BBHZ
Policy instance 3
Insurance contract or identification numberGLUG0BBHZ
Number of Individuals Covered196
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $9,144
Total amount of fees paid to insurance companyUSD $10,006
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $91,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,487
Amount paid for insurance broker fees4174
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BBHZ
Policy instance 3
Insurance contract or identification numberGLUG0BBHZ
Number of Individuals Covered232
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $10,515
Total amount of fees paid to insurance companyUSD $12,114
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $105,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,515
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATION
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914239
Policy instance 2
Insurance contract or identification number914239
Number of Individuals Covered136
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $45,815
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $870,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees45815
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1091403
Policy instance 1
Insurance contract or identification number1091403
Number of Individuals Covered219
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $5,714
Total amount of fees paid to insurance companyUSD $1,675
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,714
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BBHZ
Policy instance 3
Insurance contract or identification numberGLUG0BBHZ
Number of Individuals Covered240
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $8,839
Total amount of fees paid to insurance companyUSD $10,392
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $88,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,839
Amount paid for insurance broker fees5312
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914239
Policy instance 2
Insurance contract or identification number914239
Number of Individuals Covered90
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $42,589
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $603,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees42589
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT BONUS
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1091403
Policy instance 1
Insurance contract or identification number1091403
Number of Individuals Covered182
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $5,970
Total amount of fees paid to insurance companyUSD $1,105
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,970
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number450463
Policy instance 2
Insurance contract or identification number450463
Number of Individuals Covered390
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $16,872
Total amount of fees paid to insurance companyUSD $51,354
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,186,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,872
Amount paid for insurance broker fees51354
Additional information about fees paid to insurance brokerDIRECT COMPENSATION
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN OF OKLAHOMA, INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE454729
Policy instance 1
Insurance contract or identification numberE454729
Number of Individuals Covered118
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $19,362
Total amount of fees paid to insurance companyUSD $8,579
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $62,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,513
Amount paid for insurance broker fees3710
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTANA L. MAY

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