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PAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN 401k Plan overview

Plan NamePAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN
Plan identification number 501

PAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Other welfare benefit 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.

401k Sponsoring company profile

PAMC, LTD. has sponsored the creation of one or more 401k plans.

Company Name:PAMC, LTD.
Employer identification number (EIN):954230740
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-10-01

Plan Statistics for PAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN

401k plan membership statisitcs for PAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN

Measure Date Value
2017: PAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01607
Total number of active participants reported on line 7a of the Form 55002017-10-0122
Number of retired or separated participants receiving benefits2017-10-011
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-0123
Number of employers contributing to the scheme2017-10-010

Form 5500 Responses for PAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN

2017: PAMC, LTD. DBA PACIFIC ALLIANCE MEDICAL CENTER HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01First time form 5500 has been submittedYes
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10123171001
Policy instance 1
Insurance contract or identification number10123171001
Number of Individuals Covered37
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $2,796
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3341045
Policy instance 2
Insurance contract or identification number3341045
Number of Individuals Covered35
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $1,021
Total amount of fees paid to insurance companyUSD $503
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $515,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4857454
Policy instance 3
Insurance contract or identification numberE4857454
Number of Individuals Covered163
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $66,855
Total amount of fees paid to insurance companyUSD $42,221
Life Insurance Welfare BenefitYes
Other welfare benefits providedLONG TERM CARE, ACCIDENT, CRITICAL ILLNESS, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $153,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number61772
Policy instance 4
Insurance contract or identification number61772
Number of Individuals Covered16
Insurance policy start date2018-01-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $13,133
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $262,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3341045
Policy instance 5
Insurance contract or identification number3341045
Number of Individuals Covered22
Insurance policy start date2017-08-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $33,014
Total amount of fees paid to insurance companyUSD $14,390
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX67940
Policy instance 6
Insurance contract or identification numberFLX67940
Number of Individuals Covered22
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $1,014
Total amount of fees paid to insurance companyUSD $4,845
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $82,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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