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RIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN 401k Plan overview

Plan NameRIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN
Plan identification number 503

RIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Other welfare benefit cover

401k Sponsoring company profile

RIVER VALLEY PRIMARY CARE SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:RIVER VALLEY PRIMARY CARE SERVICES, INC.
Employer identification number (EIN):861082670
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032020-03-01

Plan Statistics for RIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN

401k plan membership statisitcs for RIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN

Measure Date Value
2020: RIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-03-01103
Total number of active participants reported on line 7a of the Form 55002020-03-010
Number of retired or separated participants receiving benefits2020-03-010
Number of other retired or separated participants entitled to future benefits2020-03-010
Total of all active and inactive participants2020-03-010

Form 5500 Responses for RIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN

2020: RIVER VALLEY PRIMARY CARE SERVICES, INC. LIFE INSURANCE PLAN 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01First time form 5500 has been submittedYes
2020-03-01Submission has been amendedNo
2020-03-01This submission is the final filingYes
2020-03-01This return/report is a short plan year return/report (less than 12 months)No
2020-03-01Plan is a collectively bargained planNo
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50004095
Policy instance 1
Insurance contract or identification number50004095
Number of Individuals Covered0
Insurance policy start date2020-03-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $28
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BQ72
Policy instance 2
Insurance contract or identification numberGLUG0BQ72
Number of Individuals Covered0
Insurance policy start date2020-04-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $228
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $2,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $228
Insurance broker organization code?3

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