401k Plan data: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN plan

MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN
Plan identification number	503

MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN Benefits

401k Plan Type

Welfare 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
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

URGENT CARE SERVICES GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: URGENT CARE SERVICES GROUP, LLC

Employer identification number (EIN): 043730316

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2019-07-01
503 2018-07-01
503 2017-07-01
503 2012-01-01 JAMI TINNEY
503 2011-01-01 MATTHEW MIDDENDORF
503 2010-01-01 JAMES BEHRENSMEYER JAMES BEHRENSMEYER 2011-07-28
503 2009-01-01 JAMES BEHRENSMEYER JAMES BEHRENSMEYER 2010-10-12
503 2009-01-01 JAMES BEHRENSMEYER JAMES BEHRENSMEYER 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2019-07-01
503	2018-07-01
503	2017-07-01
503	2012-01-01	JAMI TINNEY
503	2011-01-01	MATTHEW MIDDENDORF
503	2010-01-01	JAMES BEHRENSMEYER	JAMES BEHRENSMEYER	2011-07-28
503	2009-01-01	JAMES BEHRENSMEYER	JAMES BEHRENSMEYER	2010-10-12
503	2009-01-01	JAMES BEHRENSMEYER	JAMES BEHRENSMEYER	2010-10-15

Plan Statistics for MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN

401k plan membership statisitcs for MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN

Measure Date Value
2019: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 101
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 0
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 0
2018: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 105
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 102
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 102
2017: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 102
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 128
Number of retired or separated participants receiving benefits 2017-07-01 1
Number of other retired or separated participants entitled to future benefits 2017-07-01 9
Total of all active and inactive participants 2017-07-01 138
Number of employers contributing to the scheme 2017-07-01 0
2012: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 229
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 232
2011: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 304
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 368
Total of all active and inactive participants 2011-01-01 368
Total participants 2011-01-01 368
2010: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 272
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 304
Total of all active and inactive participants 2010-01-01 304
Total participants 2010-01-01 304
2009: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 272
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 272
Total of all active and inactive participants 2009-01-01 272
Total participants 2009-01-01 272

Measure	Date	Value
2019: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	101
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	0
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	0
2018: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	105
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	102
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	102
2017: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	102
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	128
Number of retired or separated participants receiving benefits	2017-07-01	1
Number of other retired or separated participants entitled to future benefits	2017-07-01	9
Total of all active and inactive participants	2017-07-01	138
Number of employers contributing to the scheme	2017-07-01	0
2012: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	229
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	232
2011: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	304
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	368
Total of all active and inactive participants	2011-01-01	368
Total participants	2011-01-01	368
2010: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	272
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	304
Total of all active and inactive participants	2010-01-01	304
Total participants	2010-01-01	304
2009: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	272
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	272
Total of all active and inactive participants	2009-01-01	272
Total participants	2009-01-01	272

Form 5500 Responses for MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN

2019: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	Yes
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	No
2018-07-01	This submission is the final filing	No
2018-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-07-01	Plan is a collectively bargained plan	No
2018-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: MEDICAL PAYROLL PROCESSING HEALTH & WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30040930

Policy instance

Insurance contract or identification number	30040930
Number of Individuals Covered	65
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,881
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 number

417248

Policy instance

Insurance contract or identification number	417248
Number of Individuals Covered	204
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $24,922
Total amount of fees paid to insurance company	USD $4,791
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $239,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	URGENT CARE SERVICES GROUP, LLC
Employer identification number (EIN):	043730316
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)