401k Plan data: SMG OPERATIONS EMPLOYEE HEALTH PLAN plan

SMG OPERATIONS EMPLOYEE HEALTH PLAN 401k Plan overview

Plan Name	SMG OPERATIONS EMPLOYEE HEALTH PLAN
Plan identification number	501

SMG OPERATIONS EMPLOYEE HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

SUMMIT MED GROUP OPERATIONS, LLC has sponsored the creation of one or more 401k plans.

Company Name: SUMMIT MED GROUP OPERATIONS, LLC

Employer identification number (EIN): 863630544

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SMG OPERATIONS EMPLOYEE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-08-01

Plan Statistics for SMG OPERATIONS EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for SMG OPERATIONS EMPLOYEE HEALTH PLAN

Measure Date Value
2022: SMG OPERATIONS EMPLOYEE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,123
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,249
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 7
Total of all active and inactive participants 2022-01-01 1,256
2021: SMG OPERATIONS EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year 2021-08-01 1,085
Total number of active participants reported on line 7a of the Form 5500 2021-08-01 1,123
Number of retired or separated participants receiving benefits 2021-08-01 0
Number of other retired or separated participants entitled to future benefits 2021-08-01 1
Total of all active and inactive participants 2021-08-01 1,124

Measure	Date	Value
2022: SMG OPERATIONS EMPLOYEE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,123
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,249
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	7
Total of all active and inactive participants	2022-01-01	1,256
2021: SMG OPERATIONS EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year	2021-08-01	1,085
Total number of active participants reported on line 7a of the Form 5500	2021-08-01	1,123
Number of retired or separated participants receiving benefits	2021-08-01	0
Number of other retired or separated participants entitled to future benefits	2021-08-01	1
Total of all active and inactive participants	2021-08-01	1,124

Form 5500 Responses for SMG OPERATIONS EMPLOYEE HEALTH PLAN

2022: SMG OPERATIONS EMPLOYEE HEALTH PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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
2021: SMG OPERATIONS EMPLOYEE HEALTH PLAN 2021 form 5500 responses
2021-08-01	Type of plan entity	Single employer plan
2021-08-01	First time form 5500 has been submitted	Yes
2021-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-08-01	Plan funding arrangement – Insurance	Yes
2021-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-08-01	Plan benefit arrangement – Insurance	Yes
2021-08-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

039746

Policy instance

Insurance contract or identification number	039746
Number of Individuals Covered	805
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,665
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $94,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,665

DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )

Policy contract number

7991

Policy instance

Insurance contract or identification number	7991
Number of Individuals Covered	1553
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

142307

Policy instance

Insurance contract or identification number	142307
Number of Individuals Covered	1367
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $491,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,000

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

Policy contract number

VPS 328952

Policy instance

Insurance contract or identification number	VPS 328952
Number of Individuals Covered	411
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $34,929
Temporary Disability 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 $34,929
Insurance broker organization code?	3

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

Policy contract number

VAR 209761

Policy instance

Insurance contract or identification number	VAR 209761
Number of Individuals Covered	1075
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,213
Life 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 $2,213
Insurance broker organization code?	3

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

Policy contract number

VAI 855324

Policy instance

Insurance contract or identification number	VAI 855324
Number of Individuals Covered	255
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,863
Temporary Disability 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 $7,863
Insurance broker organization code?	3

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

Policy contract number

GL 164669

Policy instance

Insurance contract or identification number	GL 164669
Number of Individuals Covered	1123
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $42,396
Life 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 $42,396
Insurance broker organization code?	3

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

Policy contract number

VHI 855593

Policy instance

Insurance contract or identification number	VHI 855593
Number of Individuals Covered	155
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,462
Health 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 $4,462
Insurance broker organization code?	3

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

Policy contract number

LTD 133189

Policy instance

Insurance contract or identification number	LTD 133189
Number of Individuals Covered	1524
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,377
Long Term Disability 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 $7,377
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

039746

Policy instance

Insurance contract or identification number	039746
Number of Individuals Covered	733
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,912
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,912

DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )

Policy contract number

7991

Policy instance

Insurance contract or identification number	7991
Number of Individuals Covered	1409
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

54518

Policy instance

Insurance contract or identification number	54518
Number of Individuals Covered	1243
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $245,209
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

VPS 328952

Policy instance

Insurance contract or identification number	VPS 328952
Number of Individuals Covered	415
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,918
Temporary Disability 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 $2,918
Insurance broker organization code?	3

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

Policy contract number

VAR 209761

Policy instance

Insurance contract or identification number	VAR 209761
Number of Individuals Covered	1083
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $781
Life 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 $781
Insurance broker organization code?	3

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

Policy contract number

VAI 855324

Policy instance

Insurance contract or identification number	VAI 855324
Number of Individuals Covered	255
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,839
Temporary Disability 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 $1,839
Insurance broker organization code?	3

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

Policy contract number

GL 164669

Policy instance

Insurance contract or identification number	GL 164669
Number of Individuals Covered	1085
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,804
Life 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 $11,804
Insurance broker organization code?	3

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

Policy contract number

VHI 855593

Policy instance

Insurance contract or identification number	VHI 855593
Number of Individuals Covered	159
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,388
Health 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 $1,388
Insurance broker organization code?	3

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

Policy contract number

LTD 133189

Policy instance

Insurance contract or identification number	LTD 133189
Number of Individuals Covered	1494
Insurance policy start date	2021-08-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,731
Long Term Disability 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 $1,731
Insurance broker organization code?	3

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Company Name:	SUMMIT MED GROUP OPERATIONS, LLC
Employer identification number (EIN):	863630544
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)