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FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 401k Plan overview

Plan NameFAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN
Plan identification number 504

FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

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 HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042020-08-01MOLLIE MIZE2021-07-26
5042019-08-01MOLLIE MIZE2021-01-08
5042018-08-01
5042017-08-01SHANIN MCCABE-HARDING
5042016-08-01SHANIN MCCABE-HARDING
5042015-08-01SHANIN MCCABE-HARDING
5042014-08-01SHANIN MCCABE-HARDING
5042013-08-01SHANIN MCCABE-HARDING
5042012-08-01SHANIN MCCABE-HARDING
5042011-08-01SHANIN MCCABE-HARDING
5042009-08-01SHANIN MCCABE-HARDING

Plan Statistics for FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN

401k plan membership statisitcs for FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN

Measure Date Value
2020: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-08-01151
Total number of active participants reported on line 7a of the Form 55002020-08-010
Number of retired or separated participants receiving benefits2020-08-010
Number of other retired or separated participants entitled to future benefits2020-08-010
Total of all active and inactive participants2020-08-010
2019: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-08-01198
Total number of active participants reported on line 7a of the Form 55002019-08-01151
Number of retired or separated participants receiving benefits2019-08-010
Number of other retired or separated participants entitled to future benefits2019-08-010
Total of all active and inactive participants2019-08-01151
2018: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-08-01205
Total number of active participants reported on line 7a of the Form 55002018-08-01198
Number of retired or separated participants receiving benefits2018-08-010
Number of other retired or separated participants entitled to future benefits2018-08-010
Total of all active and inactive participants2018-08-01198
2017: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-01198
Total number of active participants reported on line 7a of the Form 55002017-08-01205
Number of retired or separated participants receiving benefits2017-08-010
Number of other retired or separated participants entitled to future benefits2017-08-010
Total of all active and inactive participants2017-08-01205
2016: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01198
Total number of active participants reported on line 7a of the Form 55002016-08-01198
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 participants2016-08-01198
2015: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01195
Total number of active participants reported on line 7a of the Form 55002015-08-01198
Number of retired or separated participants receiving benefits2015-08-010
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01198
2014: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01183
Total number of active participants reported on line 7a of the Form 55002014-08-01195
Number of retired or separated participants receiving benefits2014-08-010
Number of other retired or separated participants entitled to future benefits2014-08-010
Total of all active and inactive participants2014-08-01195
2013: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01164
Total number of active participants reported on line 7a of the Form 55002013-08-01183
Total of all active and inactive participants2013-08-01183
2012: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-01145
Total number of active participants reported on line 7a of the Form 55002012-08-01164
Total of all active and inactive participants2012-08-01164
2011: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-01145
Total number of active participants reported on line 7a of the Form 55002011-08-01145
Total of all active and inactive participants2011-08-01145
2009: FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-01129
Total number of active participants reported on line 7a of the Form 55002009-08-01137
Total of all active and inactive participants2009-08-01137

Form 5500 Responses for FAMILY HEALTH CARE OF SIOUXLAND PLC GROUP HEALTH INSURANCE PLAN

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

Insurance Providers Used on plan

WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number450
Policy instance 1
Insurance contract or identification number450
Number of Individuals Covered158
Insurance policy start date2020-08-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,993
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,993
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number450
Policy instance 1
Insurance contract or identification number450
Number of Individuals Covered151
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $18,306
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $18,306
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number450
Policy instance 1
Insurance contract or identification number450
Number of Individuals Covered198
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $21,744
Other welfare benefits providedHOSP/MED-SURGICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,744
Additional information about fees paid to insurance brokerINDIRECT COMMISISON ALLOCATION
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number450
Policy instance 1
Insurance contract or identification number450
Number of Individuals Covered205
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $22,104
Other welfare benefits providedHOSP/MED-SURGICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number450
Policy instance 1
Insurance contract or identification number450
Number of Individuals Covered198
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of fees paid to insurance companyUSD $21,474
Other welfare benefits providedHOSP/MED-SURGICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees21474
Additional information about fees paid to insurance brokerINDIRECT COMMISISON ALLOCATION
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number450
Policy instance 1
Insurance contract or identification number450
Number of Individuals Covered195
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $20,358
Total amount of fees paid to insurance companyUSD $9,930
Other welfare benefits providedHOSP/MED-SURGICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,358
Amount paid for insurance broker fees9930
Additional information about fees paid to insurance brokerINDIRECT COMMISISON ALLOCATION
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number22700
Policy instance 1
Insurance contract or identification number22700
Number of Individuals Covered171
Insurance policy start date2013-08-01
Insurance policy end date2013-12-31
Welfare Benefit Premiums Paid to CarrierUSD $111,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number450
Policy instance 2
Insurance contract or identification number450
Number of Individuals Covered183
Insurance policy start date2014-01-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $11,223
Other welfare benefits providedHOSP/MED/SURGICAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,223
Insurance broker organization code?5
Insurance broker nameWELLMARK BLUE CROSS & BLUE SHLD SD
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number22700
Policy instance 1
Insurance contract or identification number22700
Number of Individuals Covered164
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Welfare Benefit Premiums Paid to CarrierUSD $253,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number22700
Policy instance 1
Insurance contract or identification number22700
Number of Individuals Covered145
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Welfare Benefit Premiums Paid to CarrierUSD $235,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number22700
Policy instance 1
Insurance contract or identification number22700
Number of Individuals Covered145
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $219,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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