401k Plan data: HIGHMARK MEDICAL plan

HIGHMARK MEDICAL 401k Plan overview

Plan Name	HIGHMARK MEDICAL
Plan identification number	502

HIGHMARK MEDICAL Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental

401k Sponsoring company profile

ENT AND ALLERGY OF DELAWARE LLC has sponsored the creation of one or more 401k plans.

Company Name: ENT AND ALLERGY OF DELAWARE LLC

Employer identification number (EIN): 273624677

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HIGHMARK MEDICAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-10-01
502 2022-10-01

Plan Statistics for HIGHMARK MEDICAL

401k plan membership statisitcs for HIGHMARK MEDICAL

Measure Date Value
2023: HIGHMARK MEDICAL 2023 401k membership
Total participants, beginning-of-year 2023-10-01 217
Total number of active participants reported on line 7a of the Form 5500 2023-10-01 0
Number of retired or separated participants receiving benefits 2023-10-01 0
Number of other retired or separated participants entitled to future benefits 2023-10-01 0
Total of all active and inactive participants 2023-10-01 0
2022: HIGHMARK MEDICAL 2022 401k membership
Total participants, beginning-of-year 2022-10-01 120
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 217
Number of retired or separated participants receiving benefits 2022-10-01 1
Number of other retired or separated participants entitled to future benefits 2022-10-01 43
Total of all active and inactive participants 2022-10-01 261

Measure	Date	Value
2023: HIGHMARK MEDICAL 2023 401k membership
Total participants, beginning-of-year	2023-10-01	217
Total number of active participants reported on line 7a of the Form 5500	2023-10-01	0
Number of retired or separated participants receiving benefits	2023-10-01	0
Number of other retired or separated participants entitled to future benefits	2023-10-01	0
Total of all active and inactive participants	2023-10-01	0
2022: HIGHMARK MEDICAL 2022 401k membership
Total participants, beginning-of-year	2022-10-01	120
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	217
Number of retired or separated participants receiving benefits	2022-10-01	1
Number of other retired or separated participants entitled to future benefits	2022-10-01	43
Total of all active and inactive participants	2022-10-01	261

Form 5500 Responses for HIGHMARK MEDICAL

2023: HIGHMARK MEDICAL 2023 form 5500 responses
2023-10-01	Type of plan entity	Single employer plan
2023-10-01	Submission has been amended	No
2023-10-01	This submission is the final filing	Yes
2023-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-10-01	Plan is a collectively bargained plan	No
2023-10-01	Plan funding arrangement – Insurance	Yes
2023-10-01	Plan benefit arrangement – Insurance	Yes
2022: HIGHMARK MEDICAL 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	First time form 5500 has been submitted	Yes
2022-10-01	Submission has been amended	No
2022-10-01	This submission is the final filing	No
2022-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-10-01	Plan is a collectively bargained plan	No
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 )

Policy contract number

133346

Policy instance

Insurance contract or identification number	133346
Number of Individuals Covered	169
Insurance policy start date	2023-10-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $16,273
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $515,460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 )

Policy contract number

133346

Policy instance

Insurance contract or identification number	133346
Number of Individuals Covered	156
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $49,889
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $1,582,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,599
Insurance broker organization code?	3

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Company Name:	ENT AND ALLERGY OF DELAWARE LLC
Employer identification number (EIN):	273624677
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)