401k Plan data: VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN plan

VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN 401k Plan overview

Plan Name	VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN
Plan identification number	501

VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN Benefits

401k Plan Type	Welfare 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

VMD PRIMARY PROVIDERS OF ARIZONA, PLLC has sponsored the creation of one or more 401k plans.

Company Name: VMD PRIMARY PROVIDERS OF ARIZONA, PLLC

Employer identification number (EIN): 842135130

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 AMY SMITH 2023-08-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	AMY SMITH	2023-08-16

Plan Statistics for VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN

401k plan membership statisitcs for VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN

Measure Date Value
2022: VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 324
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 667
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 667
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	324
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	667
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	667
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN

2022: VMD PRIMARY PROVIDERS OF ARIZONA WRAP PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30047837

Policy instance

Insurance contract or identification number	30047837
Number of Individuals Covered	4181
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $24,202
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $361,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,102
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

EVERNORTH CARE SOLUTIONS, INC (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2501447

Policy instance

Insurance contract or identification number	2501447
Number of Individuals Covered	5750
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $46,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL165267

Policy instance

Insurance contract or identification number	GL165267
Number of Individuals Covered	3735
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $83,869
Total amount of fees paid to insurance company	USD $165,449
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	ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,654,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $83,869
Amount paid for insurance broker fees	165449
Additional information about fees paid to insurance broker	TOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?	3

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Company Name:	VMD PRIMARY PROVIDERS OF ARIZONA, PLLC
Employer identification number (EIN):	842135130
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)