HIAWATHA COMMUNITY HOSPITAL has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HIAWATHA HOSPITAL ASSOCIATION INC DBA AMBERWELL HIAWATHA HEALTH AND WELFARE PLAN
401k plan membership statisitcs for HIAWATHA HOSPITAL ASSOCIATION INC DBA AMBERWELL HIAWATHA HEALTH AND WELFARE PLAN
| VISION CARE DIRECT OF KANSAS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 4027 |
| Policy instance | 1 |
| Insurance contract or identification number | 4027 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,032 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,032 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-020238-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-020238-00 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,922 | | Total amount of fees paid to insurance company | USD $1,676 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $39,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $3,922 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS |
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| NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 ) |
| Policy contract number | 1012021 |
| Policy instance | 3 |
| Insurance contract or identification number | 1012021 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $3,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | AGC0000159533 |
| Policy instance | 4 |
| Insurance contract or identification number | AGC0000159533 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,619 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $14,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,453 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| MEDICAL AIR SERVICES ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 62191 ) |
| Policy contract number | B2BHIAWA |
| Policy instance | 5 |
| Insurance contract or identification number | B2BHIAWA | | Number of Individuals Covered | 57 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,485 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMERGENCY TRANSPORT | | Welfare Benefit Premiums Paid to Carrier | USD $9,893 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $801 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226627-0014 |
| Policy instance | 6 |
| Insurance contract or identification number | 12226627-0014 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $536 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $14,368 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $428 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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