401k Plan data: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN plan

THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

OAKLEAF CLINICS, INC. has sponsored the creation of one or more 401k plans.

Company Name: OAKLEAF CLINICS, INC.

Employer identification number (EIN): 274563392

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-09-01
501 2020-09-01
501 2019-09-01
501 2018-09-01

Plan Statistics for THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2020: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-09-01 133
Total number of active participants reported on line 7a of the Form 5500 2020-09-01 139
Number of retired or separated participants receiving benefits 2020-09-01 0
Number of other retired or separated participants entitled to future benefits 2020-09-01 0
Total of all active and inactive participants 2020-09-01 139
Total participants 2020-09-01 0
2019: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-09-01 119
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 130
Total of all active and inactive participants 2019-09-01 130
2018: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-09-01 103
Total number of active participants reported on line 7a of the Form 5500 2018-09-01 119
Total of all active and inactive participants 2018-09-01 119

Measure	Date	Value
2020: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-01	133
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	139
Number of retired or separated participants receiving benefits	2020-09-01	0
Number of other retired or separated participants entitled to future benefits	2020-09-01	0
Total of all active and inactive participants	2020-09-01	139
Total participants	2020-09-01	0
2019: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	119
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	130
Total of all active and inactive participants	2019-09-01	130
2018: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-09-01	103
Total number of active participants reported on line 7a of the Form 5500	2018-09-01	119
Total of all active and inactive participants	2018-09-01	119

Form 5500 Responses for THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN

2020: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Submission has been amended	No
2020-09-01	This submission is the final filing	No
2020-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-09-01	Plan is a collectively bargained plan	No
2020-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Submission has been amended	No
2019-09-01	This submission is the final filing	No
2019-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-09-01	Plan is a collectively bargained plan	No
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: THE OAKLEAF CLINICS, SC HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	First time form 5500 has been submitted	Yes
2018-09-01	Submission has been amended	No
2018-09-01	This submission is the final filing	No
2018-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-09-01	Plan is a collectively bargained plan	No
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 53139 )

Policy contract number

10010810

Policy instance

Insurance contract or identification number	10010810
Number of Individuals Covered	348
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $74,224
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,861,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $74,224
Insurance broker organization code?	1

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Company Name:	OAKLEAF CLINICS, INC.
Employer identification number (EIN):	274563392
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)