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INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameINFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN
Plan identification number 501

INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance

401k Sponsoring company profile

INFECTIOUS DISEASE OF INDIANA has sponsored the creation of one or more 401k plans.

Company Name:INFECTIOUS DISEASE OF INDIANA
Employer identification number (EIN):351625259
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-08-01MARLA VANDEVENDER
5012014-08-01MARLA VANDEVENDER
5012013-08-01MARLA VANDEVENDER
5012012-08-01MARLE VANDEVENDER
5012011-08-01MARLE VANDEVENDER

Plan Statistics for INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN

Measure Date Value
2015: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-0136
Total number of active participants reported on line 7a of the Form 55002015-08-0116
Total of all active and inactive participants2015-08-0116
Total participants2015-08-0116
2014: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-0131
Total number of active participants reported on line 7a of the Form 55002014-08-0135
Total of all active and inactive participants2014-08-0135
Total participants2014-08-0135
2013: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-0129
Total number of active participants reported on line 7a of the Form 55002013-08-0136
Total of all active and inactive participants2013-08-0136
Total participants2013-08-0136
2012: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-0130
Total number of active participants reported on line 7a of the Form 55002012-08-0129
Total of all active and inactive participants2012-08-0129
Total participants2012-08-010
2011: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-0125
Total number of active participants reported on line 7a of the Form 55002011-08-0126
Total of all active and inactive participants2011-08-0126
Total participants2011-08-0126

Form 5500 Responses for INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN

2015: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)No
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan funding arrangement – General assets of the sponsorYes
2015-08-01Plan benefit arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – General assets of the sponsorYes
2014: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)No
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan funding arrangement – General assets of the sponsorYes
2014-08-01Plan benefit arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – General assets of the sponsorYes
2013: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan funding arrangement – General assets of the sponsorYes
2013-08-01Plan benefit arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – General assets of the sponsorYes
2012: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan funding arrangement – General assets of the sponsorYes
2012-08-01Plan benefit arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – General assets of the sponsorYes
2011: INFECTIOUS DISEASE OF INDIANA EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan funding arrangement – General assets of the sponsorYes
2011-08-01Plan benefit arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE1I51045
Policy instance 1
Insurance contract or identification numberSE1I51045
Number of Individuals Covered16
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $8,719
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $108,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,719
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE1I50853
Policy instance 1
Insurance contract or identification numberSE1I50853
Number of Individuals Covered35
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $12,478
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $145,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,478
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE1I50853
Policy instance 1
Insurance contract or identification numberSE1I50853
Number of Individuals Covered36
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $12,082
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $127,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,082
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3150701
Policy instance 1
Insurance contract or identification numberSE3150701
Number of Individuals Covered29
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $10,023
Total amount of fees paid to insurance companyUSD $716
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $125,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,023
Amount paid for insurance broker fees716
Additional information about fees paid to insurance brokerSTOPLOSS, NW AND HCM COMPERSATION
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE3150701
Policy instance 1
Insurance contract or identification numberSE3150701
Number of Individuals Covered26
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $9,385
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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