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WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN 401k Plan overview

Plan NameWEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN
Plan identification number 501

WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE 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)
  • Other welfare benefit cover

401k Sponsoring company profile

WEST SIDE COMMUNITY HEALTH SERVICES has sponsored the creation of one or more 401k plans.

Company Name:WEST SIDE COMMUNITY HEALTH SERVICES
Employer identification number (EIN):237156236
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01REUBEN MOORE2024-05-20
5012022-01-01BOAKAI DORLEY2023-05-26

Plan Statistics for WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN

401k plan membership statisitcs for WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN

Measure Date Value
2023: WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01365
Total number of active participants reported on line 7a of the Form 55002023-01-01360
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01360
Number of employers contributing to the scheme2023-01-010
2022: WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01407
Total number of active participants reported on line 7a of the Form 55002022-01-01365
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01365
Number of employers contributing to the scheme2022-01-010

Form 5500 Responses for WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN

2023: WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: WEST SIDE COMMUNITY HEALTH SERVICES HEALTH CARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01First time form 5500 has been submittedYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

COUNSELING GLOBAL DOMESTIC (National Association of Insurance Commissioners NAIC id number: 54161 )
Policy contract number400795
Policy instance 1
Insurance contract or identification number400795
Number of Individuals Covered360
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $16,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10308491001
Policy instance 2
Insurance contract or identification number10308491001
Number of Individuals Covered370
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $3,254
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BLDS
Policy instance 3
Insurance contract or identification numberGLUG0BLDS
Number of Individuals Covered347
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $22,992
Total amount of fees paid to insurance companyUSD $25,456
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $229,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COUNSELING GLOBAL DOMESTIC (National Association of Insurance Commissioners NAIC id number: 54161 )
Policy contract number400795
Policy instance 1
Insurance contract or identification number400795
Number of Individuals Covered360
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $21,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10308491001
Policy instance 2
Insurance contract or identification number10308491001
Number of Individuals Covered373
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,306
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $4,306
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BLDS
Policy instance 3
Insurance contract or identification numberGLUG0BLDS
Number of Individuals Covered365
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $31,390
Total amount of fees paid to insurance companyUSD $23,037
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $313,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,390
Amount paid for insurance broker fees23037
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3

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