401k Plan data: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN plan

PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 401k Plan overview

Plan Name	PRAIRIE LAKES HEALTHCARE SYSTEM PLAN
Plan identification number	506

PRAIRIE LAKES HEALTHCARE SYSTEM PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness)

401k Sponsoring company profile

PRAIRIE LAKES HEALTHCARE SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: PRAIRIE LAKES HEALTHCARE SYSTEM

Employer identification number (EIN): 460391067

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRAIRIE LAKES HEALTHCARE SYSTEM PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2022-01-01
506 2021-01-01
506 2020-01-01
506 2019-01-01
506 2018-01-01

Plan Statistics for PRAIRIE LAKES HEALTHCARE SYSTEM PLAN

401k plan membership statisitcs for PRAIRIE LAKES HEALTHCARE SYSTEM PLAN

Measure Date Value
2022: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 261
Total of all active and inactive participants 2022-01-01 261
Total participants 2022-01-01 261
2021: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 231
Total of all active and inactive participants 2021-01-01 231
Total participants 2021-01-01 231
2020: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 253
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 243
Total of all active and inactive participants 2020-01-01 243
Total participants 2020-01-01 243
2019: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 245
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 253
Total of all active and inactive participants 2019-01-01 253
Total participants 2019-01-01 253
2018: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 228
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 245
Total of all active and inactive participants 2018-01-01 245
Total participants 2018-01-01 245

Measure	Date	Value
2022: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	261
Total of all active and inactive participants	2022-01-01	261
Total participants	2022-01-01	261
2021: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	231
Total of all active and inactive participants	2021-01-01	231
Total participants	2021-01-01	231
2020: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	253
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	243
Total of all active and inactive participants	2020-01-01	243
Total participants	2020-01-01	243
2019: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	245
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	253
Total of all active and inactive participants	2019-01-01	253
Total participants	2019-01-01	253
2018: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	228
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	245
Total of all active and inactive participants	2018-01-01	245
Total participants	2018-01-01	245

Form 5500 Responses for PRAIRIE LAKES HEALTHCARE SYSTEM PLAN

2022: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: PRAIRIE LAKES HEALTHCARE SYSTEM PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0CGZ7

Policy instance

Insurance contract or identification number	0CGZ7
Number of Individuals Covered	261
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $39,983
Total amount of fees paid to insurance company	USD $1,433
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $1
Amount paid for insurance broker fees	0

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OCGZ7

Policy instance

Insurance contract or identification number	OCGZ7
Number of Individuals Covered	231
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $38,042
Total amount of fees paid to insurance company	USD $1,115
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $327
Amount paid for insurance broker fees	9

DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

OCGZ7

Policy instance

Insurance contract or identification number	OCGZ7
Number of Individuals Covered	243
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $38,042
Total amount of fees paid to insurance company	USD $1,115
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7
Amount paid for insurance broker fees	17

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

OCGZ7

Policy instance

Insurance contract or identification number	OCGZ7
Number of Individuals Covered	253
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $33,304
Total amount of fees paid to insurance company	USD $1,749
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,342
Amount paid for insurance broker fees	825

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

0CGZ7

Policy instance

Insurance contract or identification number	G1006568 1002
Number of Individuals Covered	70
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $3,544
Total amount of fees paid to insurance company	USD $709
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 $71,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,544
Amount paid for insurance broker fees	709
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	PRAIRIE LAKES HEALTHCARE SYSTEM
Employer identification number (EIN):	460391067
NAIC Classification:	622000
NAIC Description:	Hospitals