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FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 401k Plan overview

Plan NameFAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN
Plan identification number 502

FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

FAMILY HEALTH CARE OF SIOUXLAND, PLC has sponsored the creation of one or more 401k plans.

Company Name:FAMILY HEALTH CARE OF SIOUXLAND, PLC
Employer identification number (EIN):753057963
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022020-07-01MOLLIE MIZE2021-07-26
5022019-07-01MOLLIE MIZE2021-01-08
5022018-07-01
5022018-07-01
5022018-07-01
5022018-07-01
5022017-07-01
5022016-08-01SHANIN MCCABE-HARDING
5022016-07-01SHANIN MCCABE-HARDING
5022015-07-01SHANIN MCCABE-HARDING
5022014-07-01SHANIN MCCABE-HARDING
5022013-07-01SHANIN MCCABE-HARDING
5022012-07-01SHANIN MCCABE-HARDING
5022011-07-01SHANIN MCCABE-HARDING
5022009-07-01SHANIN MCCABE-HARDING

Plan Statistics for FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN

401k plan membership statisitcs for FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN

Measure Date Value
2020: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01218
Total number of active participants reported on line 7a of the Form 55002020-07-010
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-010
2019: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01234
Total number of active participants reported on line 7a of the Form 55002019-07-01218
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01218
2018: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01258
Total number of active participants reported on line 7a of the Form 55002018-07-01234
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01234
2017: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01231
Total number of active participants reported on line 7a of the Form 55002017-07-01258
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01258
2016: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01231
Total number of active participants reported on line 7a of the Form 55002016-08-01231
Number of retired or separated participants receiving benefits2016-08-010
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-01231
Total participants, beginning-of-year2016-07-01231
Total number of active participants reported on line 7a of the Form 55002016-07-01231
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01231
2015: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01226
Total number of active participants reported on line 7a of the Form 55002015-07-01231
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01231
2014: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01211
Total number of active participants reported on line 7a of the Form 55002014-07-01226
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01226
2013: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01203
Total number of active participants reported on line 7a of the Form 55002013-07-01211
Total of all active and inactive participants2013-07-01211
2012: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01199
Total number of active participants reported on line 7a of the Form 55002012-07-01203
Total of all active and inactive participants2012-07-01203
2011: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01183
Total number of active participants reported on line 7a of the Form 55002011-07-01199
Total of all active and inactive participants2011-07-01199
2009: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01169
Total number of active participants reported on line 7a of the Form 55002009-07-01177
Total of all active and inactive participants2009-07-01177

Form 5500 Responses for FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN

2020: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingYes
2020-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedYes
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – InsuranceYes
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2009: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP LIFE AD&D PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01This submission is the final filingNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number768327G
Policy instance 1
Insurance contract or identification number768327G
Number of Individuals Covered199
Insurance policy start date2020-07-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,143
Total amount of fees paid to insurance companyUSD $851
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $13,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,143
Amount paid for insurance broker fees851
Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number768327G
Policy instance 1
Insurance contract or identification number768327G
Number of Individuals Covered218
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $3,281
Total amount of fees paid to insurance companyUSD $480
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $15,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,281
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 148844
Policy instance 1
Insurance contract or identification numberGL 148844
Number of Individuals Covered231
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $13,027
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,027
Additional information about fees paid to insurance brokerBROKER SERVICES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 148844
Policy instance 1
Insurance contract or identification numberGL 148844
Number of Individuals Covered231
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $12,714
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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