401k Plan data: ARIEL CLINICAL SERVICES plan

ARIEL CLINICAL SERVICES 401k Plan overview

Plan Name	ARIEL CLINICAL SERVICES
Plan identification number	501

ARIEL CLINICAL SERVICES Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Vision
Temporary disability (accident and sickness)
Death benefits (include travel accident but not life insurance)
Other welfare benefit cover
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ARIEL CLINICAL SERVICES has sponsored the creation of one or more 401k plans.

Company Name: ARIEL CLINICAL SERVICES

Employer identification number (EIN): 841255228

NAIC Classification: 624200

Additional information about ARIEL CLINICAL SERVICES

Jurisdiction of Incorporation: Colorado Department of State

Incorporation Date: 1993-12-23

Company Identification Number: 19931141849

Legal Registered Office Address: 2938 NORTH AVE.
SUITE G
GRAND JUNCTION
United States of America (USA)
81504

More information about ARIEL CLINICAL SERVICES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARIEL CLINICAL SERVICES

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-12-01 JOANNA STORTZ 2023-06-15
501 2020-12-01 LISA MARTIN 2022-06-21
501 2019-12-01 LISA MARTIN 2021-06-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2021-12-01	JOANNA STORTZ	2023-06-15
501	2020-12-01	LISA MARTIN	2022-06-21
501	2019-12-01	LISA MARTIN	2021-06-08

Plan Statistics for ARIEL CLINICAL SERVICES

401k plan membership statisitcs for ARIEL CLINICAL SERVICES

Measure Date Value
2021: ARIEL CLINICAL SERVICES 2021 401k membership
Total participants, beginning-of-year 2021-12-01 92
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 157
Number of retired or separated participants receiving benefits 2021-12-01 0
Number of other retired or separated participants entitled to future benefits 2021-12-01 0
Total of all active and inactive participants 2021-12-01 157
Number of employers contributing to the scheme 2021-12-01 0
2020: ARIEL CLINICAL SERVICES 2020 401k membership
Total participants, beginning-of-year 2020-12-01 104
Total number of active participants reported on line 7a of the Form 5500 2020-12-01 92
Number of retired or separated participants receiving benefits 2020-12-01 0
Number of other retired or separated participants entitled to future benefits 2020-12-01 0
Total of all active and inactive participants 2020-12-01 92
Number of employers contributing to the scheme 2020-12-01 0
2019: ARIEL CLINICAL SERVICES 2019 401k membership
Total participants, beginning-of-year 2019-12-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-12-01 104
Number of retired or separated participants receiving benefits 2019-12-01 0
Number of other retired or separated participants entitled to future benefits 2019-12-01 0
Total of all active and inactive participants 2019-12-01 104
Number of employers contributing to the scheme 2019-12-01 0

Measure	Date	Value
2021: ARIEL CLINICAL SERVICES 2021 401k membership
Total participants, beginning-of-year	2021-12-01	92
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	157
Number of retired or separated participants receiving benefits	2021-12-01	0
Number of other retired or separated participants entitled to future benefits	2021-12-01	0
Total of all active and inactive participants	2021-12-01	157
Number of employers contributing to the scheme	2021-12-01	0
2020: ARIEL CLINICAL SERVICES 2020 401k membership
Total participants, beginning-of-year	2020-12-01	104
Total number of active participants reported on line 7a of the Form 5500	2020-12-01	92
Number of retired or separated participants receiving benefits	2020-12-01	0
Number of other retired or separated participants entitled to future benefits	2020-12-01	0
Total of all active and inactive participants	2020-12-01	92
Number of employers contributing to the scheme	2020-12-01	0
2019: ARIEL CLINICAL SERVICES 2019 401k membership
Total participants, beginning-of-year	2019-12-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-12-01	104
Number of retired or separated participants receiving benefits	2019-12-01	0
Number of other retired or separated participants entitled to future benefits	2019-12-01	0
Total of all active and inactive participants	2019-12-01	104
Number of employers contributing to the scheme	2019-12-01	0

Form 5500 Responses for ARIEL CLINICAL SERVICES

2021: ARIEL CLINICAL SERVICES 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: ARIEL CLINICAL SERVICES 2020 form 5500 responses
2020-12-01	Type of plan entity	Single employer plan
2020-12-01	Plan funding arrangement – Insurance	Yes
2020-12-01	Plan benefit arrangement – Insurance	Yes
2019: ARIEL CLINICAL SERVICES 2019 form 5500 responses
2019-12-01	Type of plan entity	Single employer plan
2019-12-01	First time form 5500 has been submitted	Yes
2019-12-01	Plan funding arrangement – Insurance	Yes
2019-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

27903

Policy instance

Insurance contract or identification number	27903
Number of Individuals Covered	48
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $1,623
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $4,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,623
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BYRJ

Policy instance

Insurance contract or identification number	GLUG0BYRJ
Number of Individuals Covered	157
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $987
Total amount of fees paid to insurance company	USD $582
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $9,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $987
Amount paid for insurance broker fees	88
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

925571

Policy instance

Insurance contract or identification number	925571
Number of Individuals Covered	120
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $30,062
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $898,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,062
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

5954716

Policy instance

Insurance contract or identification number	5954716
Number of Individuals Covered	65
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $1,567
Total amount of fees paid to insurance company	USD $113
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,175
Amount paid for insurance broker fees	45
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

57385

Policy instance

Insurance contract or identification number	57385
Number of Individuals Covered	213
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $6,806
Total amount of fees paid to insurance company	USD $2,027
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,537
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )

Policy contract number

1172

Policy instance

Insurance contract or identification number	1172
Number of Individuals Covered	147
Insurance policy start date	2022-07-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $2,076
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,076
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

5954716

Policy instance

Insurance contract or identification number	5954716
Number of Individuals Covered	57
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $995
Total amount of fees paid to insurance company	USD $53
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $567
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30086187

Policy instance

Insurance contract or identification number	30086187
Number of Individuals Covered	67
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $778
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $570
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )

Policy contract number

W1316

Policy instance

Insurance contract or identification number	W1316
Number of Individuals Covered	265
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $6,345
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,774
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC. (National Association of Insurance Commissioners NAIC id number: 95482 )

Policy contract number

8981000

Policy instance

Insurance contract or identification number	8981000
Number of Individuals Covered	92
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $19,625
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $759,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,520
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

CEE71

Policy instance

Insurance contract or identification number	CEE71
Number of Individuals Covered	17
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $2,672
Total amount of fees paid to insurance company	USD $63
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $12,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,095
Amount paid for insurance broker fees	18
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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

Policy contract number

5954716

Policy instance

Insurance contract or identification number	5954716
Number of Individuals Covered	62
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $994
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $994
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30086187

Policy instance

Insurance contract or identification number	30086187
Number of Individuals Covered	75
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $833
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $833
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )

Policy contract number

W1316

Policy instance

Insurance contract or identification number	W1316
Number of Individuals Covered	156
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $6,483
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,483
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC. (National Association of Insurance Commissioners NAIC id number: 95482 )

Policy contract number

8981000

Policy instance

Insurance contract or identification number	8981000
Number of Individuals Covered	104
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $25,060
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $736,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,060
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	ARIEL CLINICAL SERVICES
Employer identification number (EIN):	841255228
NAIC Classification:	624200

Jurisdiction of Incorporation:	Colorado Department of State
Incorporation Date:	1993-12-23
Company Identification Number:	19931141849
Legal Registered Office Address:	2938 NORTH AVE. SUITE G GRAND JUNCTION United States of America (USA) 81504