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RETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS PLAN 401k Plan overview

Plan NameRETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS PLAN
Plan identification number 511

RETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS 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

RETINA MINNESOTA MSO, LLC has sponsored the creation of one or more 401k plans.

Company Name:RETINA MINNESOTA MSO, LLC
Employer identification number (EIN):852653127
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5112023-01-01GRETCHEN POFFENBERGER2024-07-24

Plan Statistics for RETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS PLAN

401k plan membership statisitcs for RETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS PLAN

Measure Date Value
2023: RETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01174
Total number of active participants reported on line 7a of the Form 55002023-01-01244
Number of retired or separated participants receiving benefits2023-01-011
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01245
Number of employers contributing to the scheme2023-01-010

Form 5500 Responses for RETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS PLAN

2023: RETINA CONSULTANTS MINNESOTA MSO LLC COMPREHENSIVE HEALTH & WELFARE BENEFITS 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

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number929429
Policy instance 1
Insurance contract or identification number929429
Number of Individuals Covered278
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $68,738
Total amount of fees paid to insurance companyUSD $10,644
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,045,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10084051001
Policy instance 2
Insurance contract or identification number10084051001
Number of Individuals Covered438
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $2,160
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )
Policy contract numberT03339
Policy instance 3
Insurance contract or identification numberT03339
Number of Individuals Covered346
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $13,911
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number351166
Policy instance 4
Insurance contract or identification number351166
Number of Individuals Covered244
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $31,152
Total amount of fees paid to insurance companyUSD $11,042
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,LONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $351,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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