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SURGERY PARTNERS MEP 401(K) PLAN 401k Plan overview

Plan NameSURGERY PARTNERS MEP 401(K) PLAN
Plan identification number 001

SURGERY PARTNERS MEP 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

SP PRACTICE MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name:SP PRACTICE MANAGEMENT, LLC
Employer identification number (EIN):475648184
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SURGERY PARTNERS MEP 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012018-01-01
0012018-01-01
0012017-04-01JUANITA HILL

Plan Statistics for SURGERY PARTNERS MEP 401(K) PLAN

401k plan membership statisitcs for SURGERY PARTNERS MEP 401(K) PLAN

Measure Date Value
2022: SURGERY PARTNERS MEP 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01150
Total number of active participants reported on line 7a of the Form 55002022-01-01250
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0191
Total of all active and inactive participants2022-01-01341
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01341
Number of participants with account balances2022-01-01286
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: SURGERY PARTNERS MEP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01120
Total number of active participants reported on line 7a of the Form 55002021-01-01103
Number of other retired or separated participants entitled to future benefits2021-01-0147
Total of all active and inactive participants2021-01-01150
Total participants2021-01-01150
Number of participants with account balances2021-01-0175
2020: SURGERY PARTNERS MEP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01105
Total number of active participants reported on line 7a of the Form 55002020-01-0167
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0153
Total of all active and inactive participants2020-01-01120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01120
Number of participants with account balances2020-01-0181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-011
2019: SURGERY PARTNERS MEP 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0121
Total number of active participants reported on line 7a of the Form 55002019-01-0153
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0152
Total of all active and inactive participants2019-01-01105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01105
Number of participants with account balances2019-01-0178
2018: SURGERY PARTNERS MEP 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0123
Total number of active participants reported on line 7a of the Form 55002018-01-0115
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-016
Total of all active and inactive participants2018-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0121
Number of participants with account balances2018-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: SURGERY PARTNERS MEP 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-0120
Total number of active participants reported on line 7a of the Form 55002017-04-0121
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-012
Total of all active and inactive participants2017-04-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-04-010
Total participants2017-04-0123
Number of participants with account balances2017-04-0111

Financial Data on SURGERY PARTNERS MEP 401(K) PLAN

Measure Date Value
2022 : SURGERY PARTNERS MEP 401(K) PLAN 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets2022-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$0
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets to this plan2022-12-31$14,026,668
Total transfer of assets from this plan2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Expenses. Interest paid2022-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022022-12-31$0
Total income from all sources (including contributions)2022-12-31$-2,071,712
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,171,959
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,130,465
Expenses. Certain deemed distributions of participant loans2022-12-31$1,195
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,851,535
Value of total assets at end of year2022-12-31$31,782,854
Value of total assets at beginning of year2022-12-31$20,999,857
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$40,299
Total income from rents2022-12-31$0
Total interest from all sources2022-12-31$37,083
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$467,236
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$467,236
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Administrative expenses professional fees incurred2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$5,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$999,592
Participant contributions at end of year2022-12-31$116,819
Participant contributions at beginning of year2022-12-31$0
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$121,642
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$34,021
Liabilities. Value of operating payables at end of year2022-12-31$0
Liabilities. Value of operating payables at beginning of year2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-3,243,671
Value of net assets at end of year (total assets less liabilities)2022-12-31$31,782,854
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$20,999,857
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Investment advisory and management fees2022-12-31$6,278
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$15,151,415
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$19,376,691
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest on participant loans2022-12-31$2,218
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$34,865
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$13,270,406
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$3,244,214
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$1,623,166
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-3,986,236
Net investment gain/loss from pooled separate accounts2022-12-31$0
Net investment gain or loss from common/collective trusts2022-12-31$-441,330
Net gain/loss from 103.12 investment entities2022-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Assets. Invements in employer securities at end of year2022-12-31$0
Assets. Invements in employer securities at beginning of year2022-12-31$0
Assets. Value of employer real property at end of year2022-12-31$0
Assets. Value of employer real property at beginning of year2022-12-31$0
Contributions received in cash from employer2022-12-31$730,301
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,130,465
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Contract administrator fees2022-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$0
Aggregate carrying amount (costs) on sale of assets2022-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31LBMC
Accountancy firm EIN2022-12-31621199757
2021 : SURGERY PARTNERS MEP 401(K) PLAN 2021 401k financial data
Transfers to/from the plan2021-12-31$0
Total plan liabilities at end of year2021-12-31$0
Total plan liabilities at beginning of year2021-12-31$0
Total income from all sources2021-12-31$3,283,027
Expenses. Total of all expenses incurred2021-12-31$2,853,487
Benefits paid (including direct rollovers)2021-12-31$2,814,844
Total plan assets at end of year2021-12-31$20,999,857
Total plan assets at beginning of year2021-12-31$20,570,317
Value of fidelity bond covering the plan2021-12-31$5,000,000
Assets. Value of tangible personal property2021-12-31$0
Total contributions received or receivable from participants2021-12-31$369,112
Assets. Value of loans (other than to participants)2021-12-31$0
Expenses. Other expenses not covered elsewhere2021-12-31$0
Contributions received from other sources (not participants or employers)2021-12-31$197,582
Other income received2021-12-31$2,549,472
Noncash contributions received2021-12-31$0
Net income (gross income less expenses)2021-12-31$429,540
Net plan assets at end of year (total assets less liabilities)2021-12-31$20,999,857
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$20,570,317
Assets. Value of participant loans2021-12-31$0
Assets. Value of assets in partnership/joint-venture interests2021-12-31$0
Assets. Value of real-estate (other than employer real property)2021-12-31$0
Assets. Value of employer securities2021-12-31$0
Assets. Value of employer real property2021-12-31$0
Total contributions received or receivable from employer(s)2021-12-31$166,861
Value of certain deemed distributions of participant loans2021-12-31$0
Value of corrective distributions2021-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$38,643
2020 : SURGERY PARTNERS MEP 401(K) PLAN 2020 401k financial data
Transfers to/from the plan2020-12-31$454,066
Total plan liabilities at end of year2020-12-31$0
Total plan liabilities at beginning of year2020-12-31$0
Total income from all sources2020-12-31$3,344,216
Expenses. Total of all expenses incurred2020-12-31$2,174,376
Benefits paid (including direct rollovers)2020-12-31$2,136,677
Total plan assets at end of year2020-12-31$20,570,317
Total plan assets at beginning of year2020-12-31$18,946,411
Value of fidelity bond covering the plan2020-12-31$5,000,000
Total contributions received or receivable from participants2020-12-31$523,810
Expenses. Other expenses not covered elsewhere2020-12-31$0
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$2,569,799
Noncash contributions received2020-12-31$0
Net income (gross income less expenses)2020-12-31$1,169,840
Net plan assets at end of year (total assets less liabilities)2020-12-31$20,570,317
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$18,946,411
Assets. Value of participant loans2020-12-31$3,328
Total contributions received or receivable from employer(s)2020-12-31$250,607
Value of certain deemed distributions of participant loans2020-12-31$0
Value of corrective distributions2020-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$37,699
2019 : SURGERY PARTNERS MEP 401(K) PLAN 2019 401k financial data
Transfers to/from the plan2019-12-31$16,777,743
Total plan liabilities at end of year2019-12-31$0
Total plan liabilities at beginning of year2019-12-31$0
Total income from all sources2019-12-31$2,521,464
Expenses. Total of all expenses incurred2019-12-31$2,152,558
Benefits paid (including direct rollovers)2019-12-31$2,140,780
Total plan assets at end of year2019-12-31$18,946,411
Total plan assets at beginning of year2019-12-31$1,799,762
Value of fidelity bond covering the plan2019-12-31$5,000,000
Assets. Value of tangible personal property2019-12-31$0
Total contributions received or receivable from participants2019-12-31$444,819
Assets. Value of loans (other than to participants)2019-12-31$0
Expenses. Other expenses not covered elsewhere2019-12-31$0
Contributions received from other sources (not participants or employers)2019-12-31$125,412
Other income received2019-12-31$1,728,674
Noncash contributions received2019-12-31$0
Net income (gross income less expenses)2019-12-31$368,906
Net plan assets at end of year (total assets less liabilities)2019-12-31$18,946,411
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$1,799,762
Assets. Value of participant loans2019-12-31$10,225
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2019-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2019-12-31$0
Assets. Value of assets in partnership/joint-venture interests2019-12-31$0
Assets. Value of real-estate (other than employer real property)2019-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022019-12-31$0
Assets. Value of employer securities2019-12-31$0
Assets. Value of employer real property2019-12-31$0
Total contributions received or receivable from employer(s)2019-12-31$222,559
Value of certain deemed distributions of participant loans2019-12-31$0
Value of corrective distributions2019-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$11,778
2017 : SURGERY PARTNERS MEP 401(K) PLAN 2017 401k financial data
Transfers to/from the plan2017-12-31$264,692
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$168,175
Expenses. Total of all expenses incurred2017-12-31$120,529
Benefits paid (including direct rollovers)2017-12-31$120,320
Total plan assets at end of year2017-12-31$312,338
Total plan assets at beginning of year2017-12-31$0
Value of fidelity bond covering the plan2017-12-31$5,000,000
Total contributions received or receivable from participants2017-12-31$71,258
Expenses. Other expenses not covered elsewhere2017-12-31$0
Contributions received from other sources (not participants or employers)2017-12-31$4,261
Other income received2017-12-31$31,355
Noncash contributions received2017-12-31$0
Net income (gross income less expenses)2017-12-31$47,646
Net plan assets at end of year (total assets less liabilities)2017-12-31$312,338
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$0
Total contributions received or receivable from employer(s)2017-12-31$61,301
Value of certain deemed distributions of participant loans2017-12-31$0
Value of corrective distributions2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$209

Form 5500 Responses for SURGERY PARTNERS MEP 401(K) PLAN

2022: SURGERY PARTNERS MEP 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: SURGERY PARTNERS MEP 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01This submission is the final filingNo
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: SURGERY PARTNERS MEP 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulitple employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: SURGERY PARTNERS MEP 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: SURGERY PARTNERS MEP 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: SURGERY PARTNERS MEP 401(K) PLAN 2017 form 5500 responses
2017-04-01Type of plan entityMulitple employer plan
2017-04-01First time form 5500 has been submittedYes
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – TrustYes
2017-04-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number63932
Policy instance 1
Insurance contract or identification number63932
Number of Individuals Covered38
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number63932
Policy instance 1
Insurance contract or identification number63932
Number of Individuals Covered22
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number63932
Policy instance 1
Insurance contract or identification number63932
Number of Individuals Covered20
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number63932
Policy instance 1
Insurance contract or identification number63932
Number of Individuals Covered6
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
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
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number63932
Policy instance 1
Insurance contract or identification number63932
Number of Individuals Covered3
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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 BenefitNo
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 $0
Amount paid for insurance broker fees0

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