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MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN 401k Plan overview

Plan NameMID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN
Plan identification number 502

MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

MID-ATLANTIC INTERMEDIATE, LLC has sponsored the creation of one or more 401k plans.

Company Name:MID-ATLANTIC INTERMEDIATE, LLC
Employer identification number (EIN):833110807
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022023-01-01SHERRI HANSEN2024-08-05
5022022-01-01ROBERT A. EISEN2023-07-07
5022021-01-01ROBERT EISEN2022-10-05
5022020-01-01
5022019-01-01

Form 5500 Responses for MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN

2023: MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01Type of plan entityMulitple employer plan
2023-01-01This submission is the final filingYes
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulitple employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: MID-ATLANTIC INTERMEDIATE, LLC WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01First time form 5500 has been submittedYes
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3344775
Policy instance 1
Insurance contract or identification number3344775
Number of Individuals Covered1332
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,181,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3344775
Policy instance 1
Insurance contract or identification number3344775
Number of Individuals Covered1556
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $272,369
Total amount of fees paid to insurance companyUSD $66,580
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,173,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number949327
Policy instance 2
Insurance contract or identification number949327
Number of Individuals Covered6896
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $97,165
Total amount of fees paid to insurance companyUSD $55,122
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM,ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $1,040,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract number2644616
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number231511
Policy instance 2
NATIONAL IAM BENEFIT AND TRUST FUND CIGNA HEALTH AND LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number
Policy instance 2

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