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MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 401k Plan overview

Plan NameMARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN
Plan identification number 507

MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • 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

MARY BIRD PERKINS CANCER CENTER has sponsored the creation of one or more 401k plans.

Company Name:MARY BIRD PERKINS CANCER CENTER
Employer identification number (EIN):237010520
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072022-01-01LEANNA MCGEE2023-06-29 LEANNA MCGEE2023-06-29
5072021-01-01
5072020-01-01
5072019-01-01
5072018-01-01LEANNA MCGEE
5072017-01-01LEANNA MCGEE
5072016-01-01PAUL R. NOWACKI
5072015-01-01PAUL R. NOWACKI
5072014-01-01PAUL R. NOWACKI
5072013-01-01LEANNA MCGEE
5072012-01-01PAUL R. NOWACKI
5072011-01-01PAUL R. NOWACKI
5072009-01-01PAUL R. NOWACKI

Plan Statistics for MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN

401k plan membership statisitcs for MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN

Measure Date Value
2022: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01341
Total number of active participants reported on line 7a of the Form 55002022-01-01385
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01385
2021: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01300
Total number of active participants reported on line 7a of the Form 55002021-01-01332
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01332
2020: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01305
Total number of active participants reported on line 7a of the Form 55002020-01-01307
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01307
2019: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01289
Total number of active participants reported on line 7a of the Form 55002019-01-01298
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01298
2018: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01259
Total number of active participants reported on line 7a of the Form 55002018-01-01276
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01276
2017: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01294
Total number of active participants reported on line 7a of the Form 55002017-01-01259
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01259
2016: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01309
Total number of active participants reported on line 7a of the Form 55002016-01-01294
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01294
2015: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01285
Total number of active participants reported on line 7a of the Form 55002015-01-01312
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01312
2014: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01286
Total number of active participants reported on line 7a of the Form 55002014-01-01292
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01292
2013: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01243
Total number of active participants reported on line 7a of the Form 55002013-01-01271
Number of retired or separated participants receiving benefits2013-01-012
Total of all active and inactive participants2013-01-01273
2012: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01231
Total number of active participants reported on line 7a of the Form 55002012-01-01225
Total of all active and inactive participants2012-01-01225
2011: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01227
Total number of active participants reported on line 7a of the Form 55002011-01-01231
Total of all active and inactive participants2011-01-01231
2009: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01194
Total number of active participants reported on line 7a of the Form 55002009-01-01183
Number of retired or separated participants receiving benefits2009-01-010
Total of all active and inactive participants2009-01-01183

Form 5500 Responses for MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN

2022: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: MARY BIRD PERKINS CANCER CENTER LIFE, LONG-TERM DISABILITY, AND SHORT-TERM DISABILITY PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number006344
Policy instance 1
Insurance contract or identification number006344
Number of Individuals Covered397
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $39,244
Total amount of fees paid to insurance companyUSD $71,494
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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $342,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees58650
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $39,244
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number006344
Policy instance 1
Insurance contract or identification number006344
Number of Individuals Covered333
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $29,550
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $256,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,550
Insurance broker organization code?3
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number006344
Policy instance 1
Insurance contract or identification number006344
Number of Individuals Covered306
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $27,557
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $238,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,557
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5947973
Policy instance 1
Insurance contract or identification number5947973
Number of Individuals Covered461
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $45,427
Total amount of fees paid to insurance companyUSD $6,443
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $225,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,427
Amount paid for insurance broker fees54
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5947973
Policy instance 1
Insurance contract or identification number5947973
Number of Individuals Covered416
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $55
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $205,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees55
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM603689
Policy instance 1
Insurance contract or identification numberSGM603689
Number of Individuals Covered259
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $6,302
Total amount of fees paid to insurance companyUSD $965
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,302
Amount paid for insurance broker fees965
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameHUB INT'L MIDWEST
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD603634
Policy instance 2
Insurance contract or identification numberSGD603634
Number of Individuals Covered259
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $11,042
Total amount of fees paid to insurance companyUSD $1,187
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,042
Amount paid for insurance broker fees1187
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameHUB INT'L MIDWEST
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600812
Policy instance 3
Insurance contract or identification numberVDT600812
Number of Individuals Covered259
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,454
Total amount of fees paid to insurance companyUSD $1,181
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,454
Amount paid for insurance broker fees1181
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameHUB INT'L MIDWEST
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK602367
Policy instance 4
Insurance contract or identification numberSOK602367
Number of Individuals Covered259
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,470
Total amount of fees paid to insurance companyUSD $220
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $14,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,470
Amount paid for insurance broker fees220
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameHUB INT'L MIDWEST

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