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DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 401k Plan overview

Plan NameDRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN
Plan identification number 501

DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

DRUID HILLS GOLF CLUB has sponsored the creation of one or more 401k plans.

Company Name:DRUID HILLS GOLF CLUB
Employer identification number (EIN):580225900
NAIC Classification:713900

Additional information about DRUID HILLS GOLF CLUB

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 446371

More information about DRUID HILLS GOLF CLUB

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-04-01MICHELE MEDORI MICHELE MEDORI2018-10-11
5012016-04-01MICHELE MEDORI
5012015-04-01MICHELE MEDORI MICHELE MEDORI2016-10-28
5012014-04-01JAMIE ROWSEY
5012013-04-01JAMES STORY

Plan Statistics for DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN

401k plan membership statisitcs for DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN

Measure Date Value
2017: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-0185
Total number of active participants reported on line 7a of the Form 55002017-04-010
Total of all active and inactive participants2017-04-010
2016: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-0168
Total number of active participants reported on line 7a of the Form 55002016-04-0185
Number of retired or separated participants receiving benefits2016-04-010
Total of all active and inactive participants2016-04-0185
2015: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-0198
Total number of active participants reported on line 7a of the Form 55002015-04-0166
Number of retired or separated participants receiving benefits2015-04-012
Total of all active and inactive participants2015-04-0168
2014: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01126
Total number of active participants reported on line 7a of the Form 55002014-04-0196
Number of retired or separated participants receiving benefits2014-04-012
Total of all active and inactive participants2014-04-0198
2013: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01100
Total number of active participants reported on line 7a of the Form 55002013-04-01126
Total of all active and inactive participants2013-04-01126

Form 5500 Responses for DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN

2017: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingYes
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: DRUID HILLS GOLF CLUB MEDICAL BENEFIT PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01First time form 5500 has been submittedYes
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 )
Policy contract number5582
Policy instance 1
Insurance contract or identification number5582
Number of Individuals Covered109
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $24,699
Total amount of fees paid to insurance companyUSD $33
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $501,399
Commission paid to Insurance BrokerUSD $24,699
Amount paid for insurance broker fees33
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 )
Policy contract number5582
Policy instance 1
Insurance contract or identification number5582
Number of Individuals Covered117
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $21,705
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $429,500
Commission paid to Insurance BrokerUSD $21,705
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 )
Policy contract number5582
Policy instance 1
Insurance contract or identification number5582
Number of Individuals Covered96
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $20,754
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $409,483
Commission paid to Insurance BrokerUSD $20,754
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 )
Policy contract number5582
Policy instance 1
Insurance contract or identification number5582
Number of Individuals Covered126
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $19,135
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $384,887
Commission paid to Insurance BrokerUSD $19,135
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA

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