401k Plan data: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN plan

DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 401k Plan overview

Plan Name	DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN
Plan identification number	506

DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Other welfare benefit cover

401k Sponsoring company profile

DUBUQUE INTERNAL MEDICINE PC DBA GRAND RIVER MEDICAL GROUP has sponsored the creation of one or more 401k plans.

Company Name: DUBUQUE INTERNAL MEDICINE PC DBA GRAND RIVER MEDICAL GROUP

Employer identification number (EIN): 420848123

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2018-05-01
506 2017-05-01
506 2016-05-01
506 2015-05-01
506 2014-05-01
506 2013-05-01
506 2012-05-01 JEFFREY M COOPER
506 2011-05-01 MICHAEL BERG
506 2010-05-01 MICHAEL BERG
506 2009-05-01 MICHAEL BERG

Plan Statistics for DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN

401k plan membership statisitcs for DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN

Measure Date Value
2018: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-05-01 151
Total number of active participants reported on line 7a of the Form 5500 2018-05-01 0
Number of retired or separated participants receiving benefits 2018-05-01 0
Number of other retired or separated participants entitled to future benefits 2018-05-01 0
Total of all active and inactive participants 2018-05-01 0
2017: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-05-01 149
Total number of active participants reported on line 7a of the Form 5500 2017-05-01 154
Number of retired or separated participants receiving benefits 2017-05-01 0
Total of all active and inactive participants 2017-05-01 154
2016: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-05-01 140
Total number of active participants reported on line 7a of the Form 5500 2016-05-01 149
Number of retired or separated participants receiving benefits 2016-05-01 0
Total of all active and inactive participants 2016-05-01 149
2015: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-05-01 130
Total number of active participants reported on line 7a of the Form 5500 2015-05-01 140
Number of retired or separated participants receiving benefits 2015-05-01 0
Total of all active and inactive participants 2015-05-01 140
2014: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-05-01 139
Total number of active participants reported on line 7a of the Form 5500 2014-05-01 127
Number of retired or separated participants receiving benefits 2014-05-01 3
Total of all active and inactive participants 2014-05-01 130
2013: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-05-01 124
Total number of active participants reported on line 7a of the Form 5500 2013-05-01 132
Number of retired or separated participants receiving benefits 2013-05-01 7
Total of all active and inactive participants 2013-05-01 139
2012: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-05-01 125
Total number of active participants reported on line 7a of the Form 5500 2012-05-01 124
Total of all active and inactive participants 2012-05-01 124
2011: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-05-01 122
Total number of active participants reported on line 7a of the Form 5500 2011-05-01 125
Total of all active and inactive participants 2011-05-01 125
2010: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-05-01 111
Total number of active participants reported on line 7a of the Form 5500 2010-05-01 122
Total of all active and inactive participants 2010-05-01 122
2009: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-05-01 98
Total number of active participants reported on line 7a of the Form 5500 2009-05-01 111
Total of all active and inactive participants 2009-05-01 111

Measure	Date	Value
2018: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-05-01	151
Total number of active participants reported on line 7a of the Form 5500	2018-05-01	0
Number of retired or separated participants receiving benefits	2018-05-01	0
Number of other retired or separated participants entitled to future benefits	2018-05-01	0
Total of all active and inactive participants	2018-05-01	0
2017: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-05-01	149
Total number of active participants reported on line 7a of the Form 5500	2017-05-01	154
Number of retired or separated participants receiving benefits	2017-05-01	0
Total of all active and inactive participants	2017-05-01	154
2016: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-05-01	140
Total number of active participants reported on line 7a of the Form 5500	2016-05-01	149
Number of retired or separated participants receiving benefits	2016-05-01	0
Total of all active and inactive participants	2016-05-01	149
2015: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-05-01	130
Total number of active participants reported on line 7a of the Form 5500	2015-05-01	140
Number of retired or separated participants receiving benefits	2015-05-01	0
Total of all active and inactive participants	2015-05-01	140
2014: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-05-01	139
Total number of active participants reported on line 7a of the Form 5500	2014-05-01	127
Number of retired or separated participants receiving benefits	2014-05-01	3
Total of all active and inactive participants	2014-05-01	130
2013: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-05-01	124
Total number of active participants reported on line 7a of the Form 5500	2013-05-01	132
Number of retired or separated participants receiving benefits	2013-05-01	7
Total of all active and inactive participants	2013-05-01	139
2012: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-05-01	125
Total number of active participants reported on line 7a of the Form 5500	2012-05-01	124
Total of all active and inactive participants	2012-05-01	124
2011: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-05-01	122
Total number of active participants reported on line 7a of the Form 5500	2011-05-01	125
Total of all active and inactive participants	2011-05-01	125
2010: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-05-01	111
Total number of active participants reported on line 7a of the Form 5500	2010-05-01	122
Total of all active and inactive participants	2010-05-01	122
2009: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-05-01	98
Total number of active participants reported on line 7a of the Form 5500	2009-05-01	111
Total of all active and inactive participants	2009-05-01	111

Form 5500 Responses for DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN

2018: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2018 form 5500 responses
2018-05-01	Type of plan entity	Single employer plan
2018-05-01	This submission is the final filing	Yes
2018-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2018-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-05-01	Plan benefit arrangement – Insurance	Yes
2017: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2017 form 5500 responses
2017-05-01	Type of plan entity	Single employer plan
2017-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-05-01	Plan benefit arrangement – Insurance	Yes
2016: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2016 form 5500 responses
2016-05-01	Type of plan entity	Single employer plan
2016-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-05-01	Plan benefit arrangement – Insurance	Yes
2015: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2015 form 5500 responses
2015-05-01	Type of plan entity	Single employer plan
2015-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-05-01	Plan benefit arrangement – Insurance	Yes
2014: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2014 form 5500 responses
2014-05-01	Type of plan entity	Single employer plan
2014-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-05-01	Plan benefit arrangement – Insurance	Yes
2013: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2013 form 5500 responses
2013-05-01	Type of plan entity	Single employer plan
2013-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-05-01	Plan benefit arrangement – Insurance	Yes
2012: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2012 form 5500 responses
2012-05-01	Type of plan entity	Single employer plan
2012-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-05-01	Plan benefit arrangement – Insurance	Yes
2011: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2011 form 5500 responses
2011-05-01	Type of plan entity	Single employer plan
2011-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-05-01	Plan benefit arrangement – Insurance	Yes
2010: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2010 form 5500 responses
2010-05-01	Type of plan entity	Single employer plan
2010-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-05-01	Plan benefit arrangement – Insurance	Yes
2009: DUBUQUE INTERNAL MEDICINE, PC VOLUNTARY LIFE INSURANCE PLAN 2009 form 5500 responses
2009-05-01	Type of plan entity	Single employer plan
2009-05-01	This submission is the final filing	No
2009-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 154747

Policy instance

Insurance contract or identification number	GL 154747
Number of Individuals Covered	146
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,432
Total amount of fees paid to insurance company	USD $1,123
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $42,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,432
Amount paid for insurance broker fees	1123
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	PDCM INSURANCE

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4036544

Policy instance

Insurance contract or identification number	G# 4036544
Number of Individuals Covered	204
Insurance policy start date	2015-05-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,284
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $35,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,284
Insurance broker organization code?	3
Insurance broker name	FRIEDMAN FINANCIAL SERVICES, INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 154747

Policy instance

Insurance contract or identification number	GL 154747
Number of Individuals Covered	140
Insurance policy start date	2016-01-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $2,233
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $14,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,233
Insurance broker organization code?	3
Insurance broker name	PDCM INSURANCE

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4036544

Policy instance

Insurance contract or identification number	G# 4036544
Number of Individuals Covered	260
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $7,523
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $50,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,523
Insurance broker organization code?	3
Insurance broker name	FRIEDMAN FINANCIAL SERVICES, INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4036544

Policy instance

Insurance contract or identification number	G# 4036544
Number of Individuals Covered	263
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $7,257
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $48,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,257
Insurance broker organization code?	3
Insurance broker name	FRIEDMAN FINANCIAL SERVICES, INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4036544

Policy instance

Insurance contract or identification number	G# 4036544
Number of Individuals Covered	252
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,744
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $44,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,744
Insurance broker organization code?	3
Insurance broker name	FRIEDMAN FINANCIAL SERVICES, INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4036544

Policy instance

Insurance contract or identification number	G# 4036544
Number of Individuals Covered	259
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,705
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $44,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

G# 4036544

Policy instance

Insurance contract or identification number	G# 4036544
Number of Individuals Covered	249
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,911
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $39,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,911
Insurance broker organization code?	3
Insurance broker name	FRIEDMAN FINANCIAL SERVICES, INC

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Company Name:	DUBUQUE INTERNAL MEDICINE PC DBA GRAND RIVER MEDICAL GROUP
Employer identification number (EIN):	420848123
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)