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SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN
Plan identification number 501

SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT 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)

401k Sponsoring company profile

SKIN CANCER SPECIALISTS, P.C. has sponsored the creation of one or more 401k plans.

Company Name:SKIN CANCER SPECIALISTS, P.C.
Employer identification number (EIN):912197705
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-11-01BREANNE MARTIN2024-02-21
5012021-11-01MARK A. CHASTAIN, M.D.2023-05-30
5012021-01-01MARK A. CHASTAIN, M.D.2022-05-20
5012020-01-01MARK A. CHASTAIN, M.D.2021-07-26

Plan Statistics for SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN

401k plan membership statisitcs for SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN

Measure Date Value
2022: SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-11-01148
Total number of active participants reported on line 7a of the Form 55002022-11-01151
Number of retired or separated participants receiving benefits2022-11-010
Number of other retired or separated participants entitled to future benefits2022-11-010
Total of all active and inactive participants2022-11-01151
Number of employers contributing to the scheme2022-11-010
2021: SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-01146
Total number of active participants reported on line 7a of the Form 55002021-11-01148
Number of retired or separated participants receiving benefits2021-11-010
Total of all active and inactive participants2021-11-01148
Total participants, beginning-of-year2021-01-01141
Total number of active participants reported on line 7a of the Form 55002021-01-01146
Number of retired or separated participants receiving benefits2021-01-010
Total of all active and inactive participants2021-01-01146
2020: SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01126
Total number of active participants reported on line 7a of the Form 55002020-01-01141
Number of retired or separated participants receiving benefits2020-01-010
Total of all active and inactive participants2020-01-01141

Form 5500 Responses for SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN

2022: SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-11-01Type of plan entitySingle employer plan
2022-11-01Plan funding arrangement – InsuranceYes
2022-11-01Plan funding arrangement – General assets of the sponsorYes
2022-11-01Plan benefit arrangement – InsuranceYes
2022-11-01Plan benefit arrangement – General assets of the sponsorYes
2021: SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-01-01Type of plan entitySingle employer plan
2021-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: SKIN CANCER SPECIALISTS, P.C. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number74018
Policy instance 4
Insurance contract or identification number74018
Number of Individuals Covered40
Insurance policy start date2022-11-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $4,442
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS,HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $14,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,221
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberLTD/STD 948302
Policy instance 3
Insurance contract or identification numberLTD/STD 948302
Number of Individuals Covered23
Insurance policy start date2023-03-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $1,902
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,427
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberLTD/STD 948302
Policy instance 2
Insurance contract or identification numberLTD/STD 948302
Number of Individuals Covered23
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $6,194
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,645
Amount paid for insurance broker fees0
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number842120
Policy instance 1
Insurance contract or identification number842120
Number of Individuals Covered151
Insurance policy start date2022-11-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $6,045
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $49,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,045
Amount paid for insurance broker fees0
Insurance broker organization code?3
HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 )
Policy contract number842120
Policy instance 2
Insurance contract or identification number842120
Number of Individuals Covered73
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $31,473
Total amount of fees paid to insurance companyUSD $1,812
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $632,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,473
Amount paid for insurance broker fees1812
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number842120
Policy instance 1
Insurance contract or identification number842120
Number of Individuals Covered148
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $7,493
Total amount of fees paid to insurance companyUSD $261
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $69,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,126
Amount paid for insurance broker fees261
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 )
Policy contract number842120
Policy instance 2
Insurance contract or identification number842120
Number of Individuals Covered67
Insurance policy start date2021-01-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $34,779
Total amount of fees paid to insurance companyUSD $1,330
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $452,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,093
Amount paid for insurance broker fees950
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number842120
Policy instance 1
Insurance contract or identification number842120
Number of Individuals Covered146
Insurance policy start date2021-01-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $3,533
Total amount of fees paid to insurance companyUSD $2,756
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $33,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $756
Amount paid for insurance broker fees2250
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract numberGA9902
Policy instance 4
Insurance contract or identification numberGA9902
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $176
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $176
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGA9902
Policy instance 3
Insurance contract or identification numberGA9902
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $38,146
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $589,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,146
Insurance broker organization code?3
HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 )
Policy contract number842120
Policy instance 2
Insurance contract or identification number842120
Number of Individuals Covered74
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $215,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number842120
Policy instance 1
Insurance contract or identification number842120
Number of Individuals Covered141
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,077
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $11,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,077
Insurance broker organization code?3

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