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| Plan Name | BROTOLOC HEALTH CARE SYSTEMS INC HEALTH HMO FX |
| Plan identification number | 510 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BROTOLOC NORTH |
| Employer identification number (EIN): | 391572628 |
| NAIC Classification: | 621610 |
| NAIC Description: | Home Health Care Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 510 | 2019-01-01 | JOEL BREED | 2020-06-23 | ||
| 510 | 2018-01-01 | JOEL BREED | |||
| 510 | 2017-01-01 | JOEL BREED |
| Measure | Date | Value |
|---|---|---|
| 2019: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH HMO FX 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 23 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 0 |
| 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 | 0 |
| 2018: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH HMO FX 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 23 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 23 |
| Total of all active and inactive participants | 2018-01-01 | 23 |
| Total participants | 2018-01-01 | 23 |
| 2017: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH HMO FX 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 18 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 18 |
| Total of all active and inactive participants | 2017-01-01 | 18 |
| Total participants | 2017-01-01 | 18 |
| 2019: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH HMO FX 2019 form 5500 responses | ||
|---|---|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH HMO FX 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH HMO FX 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| SECURITY HEALTH PLAN OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 96881 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | C0004479067 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| SECURITY HEALTH PLAN OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 96881 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| SECURITY HEALTH PLAN OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 96881 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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