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OLYMPIC SPORT AND SPINE LIFE 401k Plan overview

Plan NameOLYMPIC SPORT AND SPINE LIFE
Plan identification number 503

OLYMPIC SPORT AND SPINE LIFE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

OLYMPIC SPORTS & SPINE PLLC has sponsored the creation of one or more 401k plans.

Company Name:OLYMPIC SPORTS & SPINE PLLC
Employer identification number (EIN):822950138
NAIC Classification:621340
NAIC Description:Offices of Physical, Occupational and Speech Therapists, and Audiologists

Additional information about OLYMPIC SPORTS & SPINE PLLC

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 2017-09-22
Company Identification Number: 604171643
Legal Registered Office Address: 6625 WAGNER WAY STE 203

GIG HARBOR
United States of America (USA)
983358392

More information about OLYMPIC SPORTS & SPINE PLLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OLYMPIC SPORT AND SPINE LIFE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01TIFFANY GUTIERREZ2023-04-26
5032021-01-01BRIAN THACKER2022-07-12
5032020-01-01BEVERLY BALTAZAR2022-03-30
5032019-01-01BEVERLY BALTAZAR2022-03-30
5032018-04-01BEVERLY BALTAZAR2022-03-30

Plan Statistics for OLYMPIC SPORT AND SPINE LIFE

401k plan membership statisitcs for OLYMPIC SPORT AND SPINE LIFE

Measure Date Value
2022: OLYMPIC SPORT AND SPINE LIFE 2022 401k membership
Total participants, beginning-of-year2022-01-01294
Total number of active participants reported on line 7a of the Form 55002022-01-01294
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01294
Number of employers contributing to the scheme2022-01-010
2021: OLYMPIC SPORT AND SPINE LIFE 2021 401k membership
Total participants, beginning-of-year2021-01-01270
Total number of active participants reported on line 7a of the Form 55002021-01-01294
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01294
Number of employers contributing to the scheme2021-01-010
2020: OLYMPIC SPORT AND SPINE LIFE 2020 401k membership
Total participants, beginning-of-year2020-01-01235
Total number of active participants reported on line 7a of the Form 55002020-01-01553
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01553
Number of employers contributing to the scheme2020-01-010
2019: OLYMPIC SPORT AND SPINE LIFE 2019 401k membership
Total participants, beginning-of-year2019-01-01102
Total number of active participants reported on line 7a of the Form 55002019-01-01235
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01235
Number of employers contributing to the scheme2019-01-010
2018: OLYMPIC SPORT AND SPINE LIFE 2018 401k membership
Total participants, beginning-of-year2018-04-01102
Total number of active participants reported on line 7a of the Form 55002018-04-01102
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01102
Number of employers contributing to the scheme2018-04-010

Form 5500 Responses for OLYMPIC SPORT AND SPINE LIFE

2022: OLYMPIC SPORT AND SPINE LIFE 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: OLYMPIC SPORT AND SPINE LIFE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: OLYMPIC SPORT AND SPINE LIFE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: OLYMPIC SPORT AND SPINE LIFE 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: OLYMPIC SPORT AND SPINE LIFE 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01First time form 5500 has been submittedYes
2018-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-017883-00
Policy instance 1
Insurance contract or identification number01-017883-00
Number of Individuals Covered294
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,315
Total amount of fees paid to insurance companyUSD $978
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $125,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $9,315
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerGROUP SUPPLEMENTAL COMMISSIONS
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-017883-00
Policy instance 1
Insurance contract or identification number01-017883-00
Number of Individuals Covered294
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,877
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $82,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $3,645
Amount paid for insurance broker fees0
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-017883-00
Policy instance 1
Insurance contract or identification number01-017883-00
Number of Individuals Covered553
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,141
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $84,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,141
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number54433243
Policy instance 1
Insurance contract or identification number54433243
Number of Individuals Covered102
Insurance policy start date2018-04-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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