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| Plan Name | IIMC DENTAL PLAN |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | INDIANA INTERNAL MEDICINE CONSULTANTS, LLC |
| Employer identification number (EIN): | 351951319 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2022-01-01 | FRANK RIZZI | 2023-07-14 | ||
| 505 | 2019-01-01 | FRANK RIZZI | 2020-07-20 |
| Measure | Date | Value |
|---|---|---|
| 2022: IIMC DENTAL PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 107 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 107 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2019: IIMC DENTAL PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 77 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 83 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 83 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2022: IIMC DENTAL PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: IIMC DENTAL PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | First time form 5500 has been submitted | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) | |||||||||||||||||||||||||
| Policy contract number | 0501180906I7 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 ) | |||||||||||||||||||||||||
| Policy contract number | 0501180906I7 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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