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| Plan Name | GROELLE & SALMON MEDICAL PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GROELLE SALMON, P.A. |
| Employer identification number (EIN): | 651093512 |
| NAIC Classification: | 541110 |
| NAIC Description: | Offices of Lawyers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2019-01-01 | KEITH MIXON | 2020-07-23 | ||
| 502 | 2019-01-01 | KEITH MIXON | 2021-10-05 | ||
| 502 | 2017-01-01 | ||||
| 502 | 2017-01-01 | KEITH MIXON | 2019-06-17 |
| Measure | Date | Value |
|---|---|---|
| 2019: GROELLE & SALMON MEDICAL PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 107 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 107 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2017: GROELLE & SALMON MEDICAL PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 111 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 111 |
| Number of employers contributing to the scheme | 2017-01-01 | 0 |
| 2019: GROELLE & SALMON MEDICAL PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | Yes |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: GROELLE & SALMON MEDICAL PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| HUMANA MEDICAL PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95270 ) | |||||||||||||||||||||||||||||
| Policy contract number | 793766 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||
| Policy contract number | 618303 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
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