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| Plan Name | PALM BEACH COUNTY MEDICAL SOCIETY, INC EMPLOYEE ANCILLARY BENEFIT(S) PLAN |
| Plan identification number | 510 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PALM BEACH COUNTY MEDICAL SOCIETY, INC. |
| Employer identification number (EIN): | 300130804 |
| NAIC Classification: | 561110 |
| NAIC Description: | Office Administrative Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 510 | 2021-03-01 | KELLY SKIDMORE | 2022-11-29 | ||
| 510 | 2021-03-01 | KELLY SKIDMORE | 2023-07-06 | ||
| 510 | 2020-03-01 | KELLY SKIDMORE | 2021-12-03 |
| Measure | Date | Value |
|---|---|---|
| 2021: PALM BEACH COUNTY MEDICAL SOCIETY, INC EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-03-01 | 199 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 230 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 230 |
| Number of employers contributing to the scheme | 2021-03-01 | 0 |
| 2020: PALM BEACH COUNTY MEDICAL SOCIETY, INC EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-03-01 | 199 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 199 |
| Number of retired or separated participants receiving benefits | 2020-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-03-01 | 0 |
| Total of all active and inactive participants | 2020-03-01 | 199 |
| Number of employers contributing to the scheme | 2020-03-01 | 0 |
| 2021: PALM BEACH COUNTY MEDICAL SOCIETY, INC EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-03-01 | Type of plan entity | Mulitple employer plan |
| 2021-03-01 | Submission has been amended | Yes |
| 2021-03-01 | This submission is the final filing | Yes |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: PALM BEACH COUNTY MEDICAL SOCIETY, INC EMPLOYEE ANCILLARY BENEFIT(S) PLAN 2020 form 5500 responses | ||
| 2020-03-01 | Type of plan entity | Mulitple employer plan |
| 2020-03-01 | First time form 5500 has been submitted | Yes |
| 2020-03-01 | Plan funding arrangement – Insurance | Yes |
| 2020-03-01 | Plan benefit arrangement – Insurance | Yes |
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 640354 | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 608121 | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||
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| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 640354 | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 608121 | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||
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