401k Plan data: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN plan

SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 401k Plan overview

Plan Name	SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN
Plan identification number	501

SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN Benefits

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

401k Sponsoring company profile

SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION

Employer identification number (EIN): 370966854

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 JEFFREY COOPER JEFFREY COOPER 2016-10-04
501 2014-01-01 JEFFREY COOPER JEFFREY COOPER 2015-07-29
501 2013-01-01 JEFFREY COOPER JEFFREY COOPER 2015-07-29
501 2012-01-01 JEFFREY COOPER JEFFREY COOPER 2015-01-09

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	JEFFREY COOPER	JEFFREY COOPER	2016-10-04
501	2014-01-01	JEFFREY COOPER	JEFFREY COOPER	2015-07-29
501	2013-01-01	JEFFREY COOPER	JEFFREY COOPER	2015-07-29
501	2012-01-01	JEFFREY COOPER	JEFFREY COOPER	2015-01-09

Plan Statistics for SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN

401k plan membership statisitcs for SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN

Measure Date Value
2015: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 219
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 223
Number of retired or separated participants receiving benefits 2015-01-01 4
Total of all active and inactive participants 2015-01-01 227
Total participants 2015-01-01 227
2014: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 237
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 209
Number of retired or separated participants receiving benefits 2014-01-01 10
Total of all active and inactive participants 2014-01-01 219
Total participants 2014-01-01 219
2013: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 248
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 231
Number of retired or separated participants receiving benefits 2013-01-01 6
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 237
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 237
2012: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 244
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 247
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 248
Total participants 2012-01-01 248

Measure	Date	Value
2015: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	219
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	223
Number of retired or separated participants receiving benefits	2015-01-01	4
Total of all active and inactive participants	2015-01-01	227
Total participants	2015-01-01	227
2014: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	237
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	209
Number of retired or separated participants receiving benefits	2014-01-01	10
Total of all active and inactive participants	2014-01-01	219
Total participants	2014-01-01	219
2013: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	248
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	231
Number of retired or separated participants receiving benefits	2013-01-01	6
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	237
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	237
2012: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	244
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	247
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	248
Total participants	2012-01-01	248

Financial Data on SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN

Measure	Date	Value
2014 : SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$510,714
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$2,270,085
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,507,386
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,507,386
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$2,270,085
Value of total assets at end of year	2014-12-31	$341,675
Value of total assets at beginning of year	2014-12-31	$68,262
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$473,196
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$266,040
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$20,286
Total non interest bearing cash at end of year	2014-12-31	$321,389
Total non interest bearing cash at beginning of year	2014-12-31	$-19,096
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-237,301
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$-169,039
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$68,262
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$2,507,386
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$1,530,849
Employer contributions (assets) at beginning of year	2014-12-31	$87,358
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
Did the plan have assets held for investment	2014-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Liabilities. Value of acquisition indebtedness at end of year	2014-12-31	$510,714
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Qualified
Accountancy firm name	2014-12-31	ODUM ACCOUNTING
Accountancy firm EIN	2014-12-31	203513443
2013 : SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$2,343,901
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$2,294,064
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$2,294,064
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,343,901
Value of total assets at end of year	2013-12-31	$68,262
Value of total assets at beginning of year	2013-12-31	$18,425
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$513,545
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$161,342
Total non interest bearing cash at end of year	2013-12-31	$-19,096
Total non interest bearing cash at beginning of year	2013-12-31	$1,989
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$49,837
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$68,262
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$18,425
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$2,294,064
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$1,669,014
Employer contributions (assets) at end of year	2013-12-31	$87,358
Employer contributions (assets) at beginning of year	2013-12-31	$16,436
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Qualified
Accountancy firm name	2013-12-31	ODUM ACCOUNTING
Accountancy firm EIN	2013-12-31	203513443
2012 : SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$2,203,629
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$2,185,204
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$2,185,204
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,203,629
Value of total assets at end of year	2012-12-31	$18,425
Value of total assets at beginning of year	2012-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$441,391
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$373,269
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$0
Liabilities. Value of operating payables at end of year	2012-12-31	$0
Total non interest bearing cash at end of year	2012-12-31	$1,989
Total non interest bearing cash at beginning of year	2012-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$18,425
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$18,425
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$2,185,204
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$1,388,969
Employer contributions (assets) at end of year	2012-12-31	$16,436
Employer contributions (assets) at beginning of year	2012-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$0
Did the plan have assets held for investment	2012-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Liabilities. Value of acquisition indebtedness at end of year	2012-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Qualified
Accountancy firm name	2012-12-31	ODUM ACCOUNTING
Accountancy firm EIN	2012-12-31	203513443

Form 5500 Responses for SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN

2015: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

404521-C

Policy instance

Insurance contract or identification number	404521-C
Number of Individuals Covered	227
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $73,141
Are there contracts with allocated funds for individual policies?	No
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 $487,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	68265
Additional information about fees paid to insurance broker	COMMISSION PAID TO BROKER FOR SPECIFIC AND AGGREGATE STOP LOSS COVERAGE
Insurance broker organization code?	3
Insurance broker name	BENEFITS BY DESIGN, INC

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

404521-B

Policy instance

Insurance contract or identification number	404521-B
Number of Individuals Covered	219
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $59,858
Are there contracts with allocated funds for individual policies?	No
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 $399,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3990
Additional information about fees paid to insurance broker	COMMISSIONS PAID FOR SPECIFIC AND AGGREGATE STOP LOSS
Insurance broker organization code?	5
Insurance broker name	BENEFITS BY DESIGN, INC

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

404521-A

Policy instance

Insurance contract or identification number	404521-A
Number of Individuals Covered	237
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $59,420
Are there contracts with allocated funds for individual policies?	No
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 $396,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	55459
Additional information about fees paid to insurance broker	COMMISSION PAID TO BROKER FOR SPECIFIC AND AGGREGATE STOP LOSS COVERAGE
Insurance broker organization code?	3
Insurance broker name	BAS

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

AFA-HA-028

Policy instance

Insurance contract or identification number	AFA-HA-028
Number of Individuals Covered	248
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $64,438
Are there contracts with allocated funds for individual policies?	No
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 $435,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4296
Additional information about fees paid to insurance broker	COMMISSIONS PAID FOR SPECIFIC AND AGGREGATE STOP LOSS
Insurance broker organization code?	5
Insurance broker name	BENEFITS BY DESIGN, INC

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
Employer identification number (EIN):	370966854
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)