401k Plan data: INTERWELL HEALTH WELFARE BENEFIT PLAN plan

INTERWELL HEALTH WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	INTERWELL HEALTH WELFARE BENEFIT PLAN
Plan identification number	501

INTERWELL HEALTH WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

INTERWELL HEALTH PARTNERS, INC. has sponsored the creation of one or more 401k plans.

Company Name: INTERWELL HEALTH PARTNERS, INC.

Employer identification number (EIN): 881507503

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INTERWELL HEALTH WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-01-01 AMY PAGE
501 2024-01-01 AMY PAGE
501 2023-01-01 AMY PAGE 2024-10-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2024-01-01	AMY PAGE
501	2024-01-01	AMY PAGE
501	2023-01-01	AMY PAGE	2024-10-10

Form 5500 Responses for INTERWELL HEALTH WELFARE BENEFIT PLAN

2023: INTERWELL HEALTH WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

303199

Policy instance

Insurance contract or identification number	303199
Number of Individuals Covered	80
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,962
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $12,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CARROT (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

INTERWELL

Policy instance

Insurance contract or identification number	INTERWELL
Number of Individuals Covered	697
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $279,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SPRING CARE, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

INTERWELL

Policy instance

Insurance contract or identification number	INTERWELL
Number of Individuals Covered	696
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $74,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

929840

Policy instance

Insurance contract or identification number	929840
Number of Individuals Covered	1296
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $19,512
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $5,653,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0C725

Policy instance

Insurance contract or identification number	GLTD0C725
Number of Individuals Covered	656
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $11,860
Total amount of fees paid to insurance company	USD $27,826
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $612,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	INTERWELL HEALTH PARTNERS, INC.
Employer identification number (EIN):	881507503
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists