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MEDCENTER ONE FLEXIBLE BENEFIT PLAN 401k Plan overview

Plan NameMEDCENTER ONE FLEXIBLE BENEFIT PLAN
Plan identification number 505

MEDCENTER ONE FLEXIBLE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

SANFORD BISMARCK has sponsored the creation of one or more 401k plans.

Company Name:SANFORD BISMARCK
Employer identification number (EIN):450226700
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDCENTER ONE FLEXIBLE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052015-01-01BILL GASSEN BILL GASSEN2016-10-10
5052014-01-01EVAN BURKETT EVAN BURKETT2015-12-11
5052013-01-01EVAN BURKETT EVAN BURKETT2015-12-11
5052012-01-01SCOTT BOEHM CRAIG LAMBRECHT2013-10-03
5052011-01-01SCOTT BOEHM CRAIG LAMBRECHT2012-10-15
5052009-01-01SCOTT BOEHM CRAIG LAMBRECHT2010-10-04

Plan Statistics for MEDCENTER ONE FLEXIBLE BENEFIT PLAN

401k plan membership statisitcs for MEDCENTER ONE FLEXIBLE BENEFIT PLAN

Measure Date Value
2015: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,645
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-010
2014: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,556
Total number of active participants reported on line 7a of the Form 55002014-01-011,645
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,645
Total participants2014-01-011,645
2013: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,485
Total number of active participants reported on line 7a of the Form 55002013-01-011,556
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-011,556
Total participants2013-01-011,556
2012: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-012,134
Total number of active participants reported on line 7a of the Form 55002012-01-012,129
Number of retired or separated participants receiving benefits2012-01-0122
Total of all active and inactive participants2012-01-012,151
Total participants2012-01-012,151
2011: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,963
Total number of active participants reported on line 7a of the Form 55002011-01-012,109
Number of retired or separated participants receiving benefits2011-01-0125
Total of all active and inactive participants2011-01-012,134
Total participants2011-01-012,134
2009: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,812
Total number of active participants reported on line 7a of the Form 55002009-01-011,988
Total of all active and inactive participants2009-01-011,988
Total participants2009-01-011,988

Form 5500 Responses for MEDCENTER ONE FLEXIBLE BENEFIT PLAN

2015: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01This submission is the final filingYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: MEDCENTER ONE FLEXIBLE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12326123
Policy instance 1
Insurance contract or identification number12326123
Number of Individuals Covered1876
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12326123
Policy instance 1
Insurance contract or identification number12326123
Number of Individuals Covered1645
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12326123
Policy instance 1
Insurance contract or identification number12326123
Number of Individuals Covered1556
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $29,260
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $29,260
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12326123
Policy instance 1
Insurance contract or identification number12326123
Number of Individuals Covered1485
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $41,966
Health Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees41966
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberH0216
Policy instance 5
Insurance contract or identification numberH0216
Number of Individuals Covered700
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $68,826
Total amount of fees paid to insurance companyUSD $299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees33518
Insurance broker nameROSALIE M DOERR
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract numberAFASLP2008406
Policy instance 4
Insurance contract or identification numberAFASLP2008406
Number of Individuals Covered1913
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $25,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees25052
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIS LLC
DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )
Policy contract number673528
Policy instance 3
Insurance contract or identification number673528
Number of Individuals Covered1507
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $51,741
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees51741
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES
SANFORD HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95683 )
Policy contract numberTPA007
Policy instance 2
Insurance contract or identification numberTPA007
Number of Individuals Covered4028
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract numberAFASLP2008189
Policy instance 4
Insurance contract or identification numberAFASLP2008189
Number of Individuals Covered1817
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $19,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19383+
Policy instance 3
Insurance contract or identification number19383+
Number of Individuals Covered3787
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $21,463
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12326123
Policy instance 2
Insurance contract or identification number12326123
Number of Individuals Covered1414
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $30,657
Vision Insurance Welfare BenefitYes
DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )
Policy contract number673528
Policy instance 1
Insurance contract or identification number673528
Number of Individuals Covered1214
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $33,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberH0216
Policy instance 5
Insurance contract or identification numberH0216
Number of Individuals Covered698
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $92,608
Total amount of fees paid to insurance companyUSD $4,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberH0216
Policy instance 5
Insurance contract or identification numberH0216
Number of Individuals Covered670
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $89,875
Total amount of fees paid to insurance companyUSD $3,533
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19383+
Policy instance 4
Insurance contract or identification number19383+
Number of Individuals Covered3504
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )
Policy contract number673528
Policy instance 3
Insurance contract or identification number673528
Number of Individuals Covered1004
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $27,864
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract numberAFASLP2008105
Policy instance 1
Insurance contract or identification numberAFASLP2008105
Number of Individuals Covered1700
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12326123
Policy instance 2
Insurance contract or identification number12326123
Number of Individuals Covered1309
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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