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| Plan Name | ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ABILENE DIAGNOSTIC CLINIC, PLLC |
| Employer identification number (EIN): | 752624216 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-01-01 | ANDEW KOUBA | 2021-10-12 | ||
| 501 | 2019-01-01 | ANDREW KOUBA | 2020-08-17 | ANDREW KOUBA | 2020-08-17 |
| 501 | 2018-01-01 | ANDREW KOUBA | 2019-09-04 | ANDREW KOUBA | 2019-09-04 |
| 501 | 2017-01-01 | ||||
| 501 | 2016-01-01 | ANDREW KOUBA | |||
| 501 | 2015-01-01 | ANDREW KOUBA | |||
| 501 | 2014-01-01 | LINDA STANLEY | |||
| 501 | 2013-01-01 | LINDA STANLEY | |||
| 501 | 2012-01-01 | LINDA STANLEY | |||
| 501 | 2011-01-01 | LINDA STANLEY | |||
| 501 | 2009-01-01 | LINDA STANLEY |
| Measure | Date | Value |
|---|---|---|
| 2020: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 264 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 242 |
| Total of all active and inactive participants | 2020-01-01 | 242 |
| 2019: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 292 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 264 |
| Total of all active and inactive participants | 2019-01-01 | 264 |
| 2018: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 356 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 292 |
| Total of all active and inactive participants | 2018-01-01 | 292 |
| 2017: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 326 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 356 |
| 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 | 356 |
| 2016: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 326 |
| Total of all active and inactive participants | 2016-01-01 | 326 |
| Total participants | 2016-01-01 | 326 |
| 2015: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 308 |
| Total of all active and inactive participants | 2015-01-01 | 308 |
| Total participants | 2015-01-01 | 0 |
| 2014: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-01-01 | 303 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 291 |
| Total of all active and inactive participants | 2014-01-01 | 291 |
| Total participants | 2014-01-01 | 0 |
| 2013: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-01-01 | 290 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 303 |
| Total of all active and inactive participants | 2013-01-01 | 303 |
| Total participants | 2013-01-01 | 0 |
| 2012: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-01-01 | 216 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 290 |
| Total of all active and inactive participants | 2012-01-01 | 290 |
| Total participants | 2012-01-01 | 0 |
| 2011: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-01-01 | 216 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 261 |
| Total of all active and inactive participants | 2011-01-01 | 261 |
| Total participants | 2011-01-01 | 261 |
| 2009: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 260 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 256 |
| Total of all active and inactive participants | 2009-01-01 | 256 |
| Total participants | 2009-01-01 | 256 |
| 2020: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2014 form 5500 responses | ||
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2013 form 5500 responses | ||
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2012 form 5500 responses | ||
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: ABILENE DIAGNOSTIC CLINIC HEALTH BENEFIT PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 73110 |
| Policy instance | 2 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-046270 |
| Policy instance | 6 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 5 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-301711 |
| Policy instance | 4 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 768291G |
| Policy instance | 3 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) | |
| Policy contract number | 69804-1 |
| Policy instance | 1 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-046270 |
| Policy instance | 6 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 768291G |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 5 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-301711 |
| Policy instance | 4 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 73110 |
| Policy instance | 2 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) | |
| Policy contract number | 69804-1 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 768291G |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 246314 |
| Policy instance | 6 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 5 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-301711 |
| Policy instance | 4 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) | |
| Policy contract number | 69804-1 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 73110 |
| Policy instance | 2 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010-041306 |
| Policy instance | 4 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | GAE60205 |
| Policy instance | 3 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 73110, 073143 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 73110 |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 037533G |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 1 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00481790 |
| Policy instance | 4 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00481790 |
| Policy instance | 4 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 73110 |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 037533G |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 0375330G |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 73110 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 3 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 73110 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 0375330G |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 4 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) | |
| Policy contract number | 67221-1 |
| Policy instance | 2 |
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) | |
| Policy contract number | S616850 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 037533GLT |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 0375330G |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 589526 |
| Policy instance | 5 |
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) | |
| Policy contract number | S616850 |
| Policy instance | 2 |
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