401k Plan data: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN plan

NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 401k Plan overview

Plan Name	NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN
Plan identification number	501

NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

NORTH IDAHO FAMILY PHYSICIANS LLC has sponsored the creation of one or more 401k plans.

Company Name: NORTH IDAHO FAMILY PHYSICIANS LLC

Employer identification number (EIN): 820504320

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-09-01 CHERYL MIKKELSEN
501 2016-09-01 ADAM JONES
501 2015-09-01 ERIC KOELSCH

Plan id#	Filing Submission Date	Name of Administrator
501	2017-09-01	CHERYL MIKKELSEN
501	2016-09-01	ADAM JONES
501	2015-09-01	ERIC KOELSCH

Plan Statistics for NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN

401k plan membership statisitcs for NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN

Measure Date Value
2017: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-09-01 121
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 97
Number of retired or separated participants receiving benefits 2017-09-01 0
Number of other retired or separated participants entitled to future benefits 2017-09-01 0
Total of all active and inactive participants 2017-09-01 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-09-01 0
Total participants 2017-09-01 97
Number of participants with account balances 2017-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-09-01 0
Number of employers contributing to the scheme 2017-09-01 0
2016: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-09-01 119
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 125
Number of retired or separated participants receiving benefits 2016-09-01 0
Number of other retired or separated participants entitled to future benefits 2016-09-01 0
Total of all active and inactive participants 2016-09-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-09-01 0
Total participants 2016-09-01 125
Number of participants with account balances 2016-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-09-01 0
Number of employers contributing to the scheme 2016-09-01 0
2015: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 103
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 113
Number of retired or separated participants receiving benefits 2015-09-01 0
Number of other retired or separated participants entitled to future benefits 2015-09-01 0
Total of all active and inactive participants 2015-09-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-09-01 0
Total participants 2015-09-01 113
Number of participants with account balances 2015-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-09-01 0
Number of employers contributing to the scheme 2015-09-01 0

Measure	Date	Value
2017: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	121
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	97
Number of retired or separated participants receiving benefits	2017-09-01	0
Number of other retired or separated participants entitled to future benefits	2017-09-01	0
Total of all active and inactive participants	2017-09-01	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-09-01	0
Total participants	2017-09-01	97
Number of participants with account balances	2017-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-09-01	0
Number of employers contributing to the scheme	2017-09-01	0
2016: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-09-01	119
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	125
Number of retired or separated participants receiving benefits	2016-09-01	0
Number of other retired or separated participants entitled to future benefits	2016-09-01	0
Total of all active and inactive participants	2016-09-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-09-01	0
Total participants	2016-09-01	125
Number of participants with account balances	2016-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-09-01	0
Number of employers contributing to the scheme	2016-09-01	0
2015: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	103
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	113
Number of retired or separated participants receiving benefits	2015-09-01	0
Number of other retired or separated participants entitled to future benefits	2015-09-01	0
Total of all active and inactive participants	2015-09-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-09-01	0
Total participants	2015-09-01	113
Number of participants with account balances	2015-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-09-01	0
Number of employers contributing to the scheme	2015-09-01	0

Form 5500 Responses for NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN

2017: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Submission has been amended	No
2017-09-01	This submission is the final filing	No
2017-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-09-01	Plan is a collectively bargained plan	No
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	First time form 5500 has been submitted	Yes
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

REGENCE BLUESHIELD OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60131 )

Policy contract number

10000600

Policy instance

Insurance contract or identification number	10000600
Number of Individuals Covered	97
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $31,634
Total amount of fees paid to insurance company	USD $2,910
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $689,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	NORTH IDAHO FAMILY PHYSICIANS LLC
Employer identification number (EIN):	820504320
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)