401k Plan data: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN plan

DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 401k Plan overview

Plan Name	DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN
Plan identification number	502

DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

DIVERSIFIED RADIOLOGY OF COLORADO, PC has sponsored the creation of one or more 401k plans.

Company Name: DIVERSIFIED RADIOLOGY OF COLORADO, PC

Employer identification number (EIN): 841156388

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2019-01-01 JEANETTE HENCMANN 2020-10-12
502 2016-01-01 TRACY WALKER
502 2015-01-01 TRACY WALKER
502 2014-01-01 TRACY WALKER
502 2013-01-01 TRACY WALKER
502 2012-01-01 TRACY WALKER
502 2011-01-01 TRACY WALKER
502 2009-01-01 TRACY WALKER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2019-01-01	JEANETTE HENCMANN	2020-10-12
502	2016-01-01	TRACY WALKER
502	2015-01-01	TRACY WALKER
502	2014-01-01	TRACY WALKER
502	2013-01-01	TRACY WALKER
502	2012-01-01	TRACY WALKER
502	2011-01-01	TRACY WALKER
502	2009-01-01	TRACY WALKER

Plan Statistics for DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN

401k plan membership statisitcs for DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN

Measure Date Value
2019: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of employers contributing to the scheme 2019-01-01 0
2016: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 89
Total of all active and inactive participants 2016-01-01 89
Total participants 2016-01-01 89
2015: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 111
Total of all active and inactive participants 2015-01-01 111
Total participants 2015-01-01 111
2014: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 112
Total of all active and inactive participants 2014-01-01 112
Total participants 2014-01-01 112
2013: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 116
Total of all active and inactive participants 2013-01-01 116
Total participants 2013-01-01 116
2012: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 110
Total of all active and inactive participants 2012-01-01 110
Total participants 2012-01-01 110
2011: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 111
Total of all active and inactive participants 2011-01-01 111
Total participants 2011-01-01 111
2009: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 118
Total of all active and inactive participants 2009-01-01 118
Total participants 2009-01-01 118

Measure	Date	Value
2019: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of employers contributing to the scheme	2019-01-01	0
2016: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	89
Total of all active and inactive participants	2016-01-01	89
Total participants	2016-01-01	89
2015: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	111
Total of all active and inactive participants	2015-01-01	111
Total participants	2015-01-01	111
2014: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	112
Total of all active and inactive participants	2014-01-01	112
Total participants	2014-01-01	112
2013: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	116
Total of all active and inactive participants	2013-01-01	116
Total participants	2013-01-01	116
2012: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	110
Total of all active and inactive participants	2012-01-01	110
Total participants	2012-01-01	110
2011: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	111
Total of all active and inactive participants	2011-01-01	111
Total participants	2011-01-01	111
2009: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	118
Total of all active and inactive participants	2009-01-01	118
Total participants	2009-01-01	118

Form 5500 Responses for DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN

2019: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	This submission is the final filing	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2016: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: DIVERSIFIED RADIOLOGY OF COLORADO PC LIFE INSURANCE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX968049

Policy instance

Insurance contract or identification number	FLX968049
Number of Individuals Covered	104
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $27,614
Total amount of fees paid to insurance company	USD $120
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $184,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,758
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OVERRIDE

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Company Name:	DIVERSIFIED RADIOLOGY OF COLORADO, PC
Employer identification number (EIN):	841156388
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)