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FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameFOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN
Plan identification number 504

FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

FOUR WINDS HEALTH LLC has sponsored the creation of one or more 401k plans.

Company Name:FOUR WINDS HEALTH LLC
Employer identification number (EIN):451273930
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042021-01-01JENNIFER HALL2022-07-27
5042020-01-01JENNIFER HALL2021-09-28

Plan Statistics for FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN

401k plan membership statisitcs for FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN

Measure Date Value
2021: FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01201
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
Number of employers contributing to the scheme2021-01-010
2020: FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01121
Total number of active participants reported on line 7a of the Form 55002020-01-01201
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01201
Number of employers contributing to the scheme2020-01-010

Form 5500 Responses for FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN

2021: FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01This submission is the final filingYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: FOUR WINDS HEALTH LLC DBA WELLSTREET URGENT CARE HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number289661
Policy instance 1
Insurance contract or identification number289661
Number of Individuals Covered106
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $12,550
Total amount of fees paid to insurance companyUSD $783
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,522
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number289661
Policy instance 2
Insurance contract or identification number289661
Number of Individuals Covered302
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $35,054
Total amount of fees paid to insurance companyUSD $1,857
Health 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 $19,176
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number289661
Policy instance 1
Insurance contract or identification number289661
Number of Individuals Covered92
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,963
Total amount of fees paid to insurance companyUSD $1,610
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,044
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
BLUE CROSS AND BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 11557 )
Policy contract number289661
Policy instance 2
Insurance contract or identification number289661
Number of Individuals Covered244
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $22,898
Total amount of fees paid to insurance companyUSD $3,925
Health 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 $20,768
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS

Potentially related plans

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