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SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 401k Plan overview

Plan NameSOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN
Plan identification number 505

SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

SOUTHDALE PEDIATRIC ASSOCIATES, LTD. has sponsored the creation of one or more 401k plans.

Company Name:SOUTHDALE PEDIATRIC ASSOCIATES, LTD.
Employer identification number (EIN):410962307
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-05-01
5052021-05-01
5052020-05-01
5052019-05-01
5052018-05-01LORI SKALLERUD LORI SKALLERUD2019-05-14
5052017-05-01LORI SKALLERUD LORI SKALLERUD2018-08-08
5052016-05-01LORI SKALLERUD LORI SKALLERUD2017-05-23
5052015-05-01LORI SKALLERUD LORI SKALLERUD2016-07-22
5052014-05-01LORI SKALLERUD LORI SKALLERUD2015-07-08
5052013-05-01LORI SKALLERUD LORI SKALLERUD2014-05-21
5052012-05-01LORI SKALLERUD LORI SKALLERUD2013-05-22
5052011-05-01LORI SKALLERUD LORI SKALLERUD2012-05-10
5052009-05-01LORI SKALLERUD LORI SKALLERUD2010-09-07

Plan Statistics for SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN

401k plan membership statisitcs for SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN

Measure Date Value
2022: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-05-01158
Total number of active participants reported on line 7a of the Form 55002022-05-01157
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-01157
2021: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-01138
Total number of active participants reported on line 7a of the Form 55002021-05-01154
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-01154
2020: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-01143
Total number of active participants reported on line 7a of the Form 55002020-05-01142
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-01142
2019: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-01138
Total number of active participants reported on line 7a of the Form 55002019-05-01145
Number of retired or separated participants receiving benefits2019-05-010
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-01145
2018: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-01132
Total number of active participants reported on line 7a of the Form 55002018-05-01140
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-01140
2017: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01123
Total number of active participants reported on line 7a of the Form 55002017-05-01128
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-01128
2016: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-01127
Total number of active participants reported on line 7a of the Form 55002016-05-01120
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-01120
2015: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-01127
Total number of active participants reported on line 7a of the Form 55002015-05-01127
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01127
2014: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01130
Total number of active participants reported on line 7a of the Form 55002014-05-01126
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01126
2013: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01125
Total number of active participants reported on line 7a of the Form 55002013-05-01130
Total of all active and inactive participants2013-05-01130
2012: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01120
Total number of active participants reported on line 7a of the Form 55002012-05-01125
Total of all active and inactive participants2012-05-01125
2011: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01120
Total number of active participants reported on line 7a of the Form 55002011-05-01118
Total of all active and inactive participants2011-05-01118
2009: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01117
Total number of active participants reported on line 7a of the Form 55002009-05-01122
Number of retired or separated participants receiving benefits2009-05-010
Number of other retired or separated participants entitled to future benefits2009-05-010
Total of all active and inactive participants2009-05-01122
Total participants2009-05-010

Form 5500 Responses for SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN

2022: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Submission has been amendedNo
2022-05-01This submission is the final filingNo
2022-05-01This return/report is a short plan year return/report (less than 12 months)No
2022-05-01Plan is a collectively bargained planNo
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – InsuranceYes
2021: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)No
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – InsuranceYes
2020: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – InsuranceYes
2019: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – InsuranceYes
2018: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedNo
2018-05-01This submission is the final filingNo
2018-05-01This return/report is a short plan year return/report (less than 12 months)No
2018-05-01Plan is a collectively bargained planNo
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes
2016: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2009: SOUTHDALE PEDIATRIC ASSOCIATES, LTD. GROUP LIFE INSURANCE PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number245158
Policy instance 1
Insurance contract or identification number245158
Number of Individuals Covered157
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $1,285
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,285
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number245158
Policy instance 1
Insurance contract or identification number245158
Number of Individuals Covered148
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $1,518
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,518
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number245158
Policy instance 1
Insurance contract or identification number245158
Number of Individuals Covered138
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $1,602
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,602
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number245158
Policy instance 1
Insurance contract or identification number245158
Number of Individuals Covered134
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $1,406
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $122
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number245158
Policy instance 1
Insurance contract or identification number245158
Number of Individuals Covered140
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $1,465
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,268
Commission paid to Insurance BrokerUSD $1,465
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number80802
Policy instance 1
Insurance contract or identification number80802
Number of Individuals Covered128
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $1,403
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,403
Insurance broker organization code?3
Insurance broker namePAUL C KRUEGER
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number048-4053-00
Policy instance 1
Insurance contract or identification number048-4053-00
Number of Individuals Covered127
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $1,400
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,400
Insurance broker organization code?3
Insurance broker namePAUL C KRUEGER
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number048-4053-00
Policy instance 1
Insurance contract or identification number048-4053-00
Number of Individuals Covered126
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $1,372
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,372
Insurance broker organization code?3
Insurance broker namePAUL C KRUEGER
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number048-4053-00
Policy instance 1
Insurance contract or identification number048-4053-00
Number of Individuals Covered130
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $1,361
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,361
Insurance broker organization code?3
Insurance broker namePAUL C KRUEGER
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number048-4053-00
Policy instance 1
Insurance contract or identification number048-4053-00
Number of Individuals Covered125
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $1,341
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,341
Insurance broker organization code?3
Insurance broker namePAUL C KRUEGER
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number048-4053-00
Policy instance 1
Insurance contract or identification number048-4053-00
Number of Individuals Covered119
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $1,318
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number048-4053-00
Policy instance 1
Insurance contract or identification number048-4053-00
Number of Individuals Covered121
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $1,323
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,080
Commission paid to Insurance BrokerUSD $1,323
Insurance broker organization code?3
Insurance broker namePAUL C KRUEGER

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