401k Plan data: DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN plan

DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN 401k Plan overview

Plan Name	DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN
Plan identification number	501

DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Other welfare benefit cover

401k Sponsoring company profile

DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC has sponsored the creation of one or more 401k plans.

Company Name: DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC

Employer identification number (EIN): 833480216

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-04-01 LESLIE CERVANTEZ 2022-01-14 LESLIE CERVANTEZ 2022-01-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-04-01	LESLIE CERVANTEZ	2022-01-14	LESLIE CERVANTEZ	2022-01-14

Plan Statistics for DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN

401k plan membership statisitcs for DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN

Measure Date Value
2020: DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN 2020 401k membership
Total participants, beginning-of-year 2020-04-01 209
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 191
Number of retired or separated participants receiving benefits 2020-04-01 2
Number of other retired or separated participants entitled to future benefits 2020-04-01 0
Total of all active and inactive participants 2020-04-01 193
Total participants 2020-04-01 193

Measure	Date	Value
2020: DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN 2020 401k membership
Total participants, beginning-of-year	2020-04-01	209
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	191
Number of retired or separated participants receiving benefits	2020-04-01	2
Number of other retired or separated participants entitled to future benefits	2020-04-01	0
Total of all active and inactive participants	2020-04-01	193
Total participants	2020-04-01	193

Form 5500 Responses for DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN

2020: DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC WRAP PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	First time form 5500 has been submitted	Yes
2020-04-01	Submission has been amended	No
2020-04-01	This submission is the final filing	No
2020-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-04-01	Plan is a collectively bargained plan	No
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00573708

Policy instance

Insurance contract or identification number	00573708
Number of Individuals Covered	174
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $77,208
Total amount of fees paid to insurance company	USD $4,976
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, VOLUNTARY CRITICAL ILLNESS AND VOLUNTARY HOSPITAL INDEMNITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $109,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,336
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KMO5969360

Policy instance

Insurance contract or identification number	KMO5969360
Number of Individuals Covered	613
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $10,485
Total amount of fees paid to insurance company	USD $2,397
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $104,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,485
Amount paid for insurance broker fees	2397
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0524600000

Policy instance

Insurance contract or identification number	0524600000
Number of Individuals Covered	114
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $68,999
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $69,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,849
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

921148

Policy instance

Insurance contract or identification number	921148
Number of Individuals Covered	440
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $11,656
Total amount of fees paid to insurance company	USD $71,059
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,477,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,656
Amount paid for insurance broker fees	71059
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

Potentially related plans

DOCTOR'S HOSPITAL OF STATEN ISLAND RETIREMENT PLAN AND TRUST AGREEMENT [EIN = 112868878]

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Company Name:	DOCTOR'S HOSPITAL MANAGEMENT SVCS., LLC
Employer identification number (EIN):	833480216
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)