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URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN 401k Plan overview

Plan NameURGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN
Plan identification number 506

URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN Benefits

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

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 URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062019-07-01
5062018-07-01

Plan Statistics for URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN

401k plan membership statisitcs for URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN

Measure Date Value
2019: URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01129
Total number of active participants reported on line 7a of the Form 55002019-07-010
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-010
2018: URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01128
Total number of active participants reported on line 7a of the Form 55002018-07-01129
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01129

Form 5500 Responses for URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN

2019: URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingYes
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: URGENT CARE GROUP SERVICES LLC BASIC ACCIDENTAL DEATH & DISMEMBERMENT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01First time form 5500 has been submittedYes
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK969895
Policy instance 1
Insurance contract or identification numberOK969895
Number of Individuals Covered142
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $395
Total amount of fees paid to insurance companyUSD $12
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $3,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $395
Insurance broker organization code?3
Amount paid for insurance broker fees12
Additional information about fees paid to insurance brokerOVERRIDE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK969895
Policy instance 1
Insurance contract or identification numberOK969895
Number of Individuals Covered129
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $267
Total amount of fees paid to insurance companyUSD $64
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 providedSUPPLEMENTAL LIFE AND DEPENDENT LIFE
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 $2,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $267
Amount paid for insurance broker fees64
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3

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