Filing

Genesis Development Employee Medical Benefit Plan

Genesis Development • EIN 23-7363533 • Plan year 2004

Company Profile Source Archive

Filing Insights

Participants

135 → 137

2 • 1.48%

Assets

No comparison

- → -

No earlier value available.

Investment Management Fee

Admin expenses - • Total expenses -

Filing Details

Context

No event flags were generated for this filing.

Status Flags

Fidelity bond in place

Not reported

Limited-scope audit performed

Not reported

Contributions transmitted on time

Not reported

Participant loans in default

Not reported

Leases in default

Not reported

Reportable party-in-interest issues

Not reported

Loss discovered during year

Not reported

Assets with undetermined value

Not reported

Non-cash contributions

Not reported

Assets held for investment

Not reported

5% transactions reported

Not reported

All plan assets distributed

Not reported

Benefits paid when due

Not reported

Plan blackout period

Not reported

Plan termination resolution adopted

Not reported

Counterparties

Company Timeline

This filing is highlighted inside the broader sponsor history.

Year / Filing	Filings	Participants	Assets	Contributions	Contrib./Participant
2019	1	0	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	0	-	-	-
2018	1	226	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	226	-	-	-
2017	1	210	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	210	-	-	-
2016	1	193	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	193	-	-	-
2015	1	189	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	189	-	-	-
2014	1	160	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	160	-	-	-
2013	1	173	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	173	-	-	-
2012	1	144	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	144	-	-	-
2011	1	130	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	130	-	-	-
2010	1	141	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	141	-	-	-
2009	2	177	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	177	-	-	-
GENESIS DEVELOPMENT FLEXIBLE BENEFITS PLAN	-	-	-	-	-
2008	1	171	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	171	-	-	-
2007	1	180	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	180	-	-	-
2006	1	148	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	148	-	-	-
2005	1	147	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	147	-	-	-
2004	1	137	$0	$0	-
Genesis Development Employee Medical Benefit Plan	Current	137	-	-	-
2001	1	78	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	78	-	-	-
2000	1	81	$0	$0	-
Genesis Development Employee Medical Benefit Plan	-	81	-	-	-

Schedule Details

Schedule A

Row 1
Filing Id: 84037012089056
Form Id: 66527432
Page Id: 2
Page Seq: 0
Page Row Num: 1
Row Num: 0
Image Form Id: 4010376012089050002
Ins Broker 01 Name: TERRY LANG
Ins Broker 01 Street Addr: 1225 RUSHRIDGE ROAD
Ins Broker 01 City: JEFFERSON
Ins Broker 01 State: IA
Ins Broker 01 ZIP Code: 50129
Ins Broker Comm Pd 01 Amount: $8,428
Ins Broker Fees Pd 01 Amount: $0
Ins Broker 01 Code: 3

Row 2
Filing Id: 84037012089056
Form Id: 66527433
Page Id: 2
Page Seq: 0
Page Row Num: 1
Row Num: 0
Image Form Id: 4010376012089050003
Ins Broker 01 Name: CBSA
Ins Broker 01 Street Addr: 400 HWY 169 S STE 800
Ins Broker 01 City: MINNEAPOLIS
Ins Broker 01 State: MN
Ins Broker 01 ZIP Code: 554261141
Ins Broker Comm Pd 01 Amount: $691
Ins Broker Fees Pd 01 Amount: $0
Ins Broker 01 Code: 5

Row 3
Filing Id: 84037012089056
Form Id: 66527433
Page Id: 2
Page Seq: 0
Page Row Num: 2
Row Num: 1
Image Form Id: 4010376012089050003
Ins Broker 01 Name: TERRY LANG
Ins Broker 01 Street Addr: 1225 RUSHRIDGE ROAD
Ins Broker 01 City: JEFFERSON
Ins Broker 01 State: IA
Ins Broker 01 ZIP Code: 50129
Ins Broker Comm Pd 01 Amount: $460
Ins Broker Fees Pd 01 Amount: $0
Ins Broker 01 Code: 3

Row 4: Ins Carrier Name: JEFFERSON PILOT
Filing Id: 84037012089056
Form Id: 66527433
Schedule A EIN: 23-7363533
Schedule A Plan Num: 501
Schedule A Plan Year Begin Date: 2004-05-01
Schedule A Tax Period: 20050430
Ins Carrier Name: JEFFERSON PILOT
Ins Carrier EIN: 62-0395665
Ins Carrier Naic Code: 70254
Ins Prsn Covered End of year Count: 137
Ins Policy From Date: 2004-05-01
Ins Policy To Date: 2005-06-30
Ins Broker Comm Total Amount: $1,151
Ins Broker Fees Total Amount: $0
Pension End of year Gen Account Amount: $0
Pension End of year Sep Account Amount: $0
Pension Prem Paid Total Amount: $0
Pension Unpaid Premium Amount: $0
Pension Contract Cost Amount: $0
Pension End Prev Bal Amount: $0
Pension Contribution Dep Amount: $0
Pension Divnd Cr Dep Amount: $0
Pension Interest Cr Dur Yr Amount: $0
Pension Transfer From Amount: $0
Pension Other Amount: $0
Pension Total Additions Amount: $0
Pension Total Bal Addn Amount: $0
Pension Bnfts Dsbrsd Amount: $0
Pension Admin Chrg Amount: $0
Pension Transfer To Amount: $0
Pension Oth Ded Amount: $0
Pension Total Ded Amount: $0
Pension End of year Bal Amount: $0
Wlfr Type Bnft Indicator: D
Wlfr Premium Rcvd Amount: $0
Wlfr Unpaid Due Amount: $0
Wlfr Reserve Amount: $0
Wlfr Total Earned Prem Amount: $0
Wlfr Claims Paid Amount: $0
Wlfr Incr Reserve Amount: $0
Wlfr Incurred Claim Amount: $0
Wlfr Claims Chrgd Amount: $0
Wlfr Ret Commissions Amount: $0
Wlfr Ret Admin Amount: $0
Wlfr Ret Oth Cost Amount: $0
Wlfr Ret Oth Expense Amount: $0
Wlfr Ret Taxes Amount: $0
Wlfr Ret Charges Amount: $0
Wlfr Ret Oth Chrgs Amount: $0
Wlfr Ret Total Amount: $0
Wlfr Refund Amount: $0
Wlfr Held Bnfts Amount: $0
Wlfr Claims Reserve Amount: $0
Wlfr Oth Reserve Amount: $0
Wlfr Divnds Due Amount: $0
Wlfr Total Charges Paid Amount: $4,604
Wlfr Acquis Cost Amount: $0

Row 5: Ins Carrier Name: HCC LIFE
Filing Id: 84037012089056
Form Id: 66527432
Schedule A EIN: 23-7363533
Schedule A Plan Num: 501
Schedule A Plan Year Begin Date: 2004-05-01
Schedule A Tax Period: 20050430
Ins Carrier Name: HCC LIFE
Ins Carrier EIN: 35-1817054
Ins Carrier Naic Code: 92711
Ins Contract Num: HCL11980
Ins Prsn Covered End of year Count: 108
Ins Policy From Date: 2004-05-01
Ins Policy To Date: 2005-04-30
Ins Broker Comm Total Amount: $8,428
Ins Broker Fees Total Amount: $0
Pension End of year Gen Account Amount: $0
Pension End of year Sep Account Amount: $0
Pension Prem Paid Total Amount: $0
Pension Unpaid Premium Amount: $0
Pension Contract Cost Amount: $0
Pension End Prev Bal Amount: $0
Pension Contribution Dep Amount: $0
Pension Divnd Cr Dep Amount: $0
Pension Interest Cr Dur Yr Amount: $0
Pension Transfer From Amount: $0
Pension Other Amount: $0
Pension Total Additions Amount: $0
Pension Total Bal Addn Amount: $0
Pension Bnfts Dsbrsd Amount: $0
Pension Admin Chrg Amount: $0
Pension Transfer To Amount: $0
Pension Oth Ded Amount: $0
Pension Total Ded Amount: $0
Pension End of year Bal Amount: $0
Wlfr Type Bnft Indicator: I
Wlfr Premium Rcvd Amount: $0
Wlfr Unpaid Due Amount: $0
Wlfr Reserve Amount: $0
Wlfr Total Earned Prem Amount: $0
Wlfr Claims Paid Amount: $0
Wlfr Incr Reserve Amount: $0
Wlfr Incurred Claim Amount: $0
Wlfr Claims Chrgd Amount: $0
Wlfr Ret Commissions Amount: $0
Wlfr Ret Admin Amount: $0
Wlfr Ret Oth Cost Amount: $0
Wlfr Ret Oth Expense Amount: $0
Wlfr Ret Taxes Amount: $0
Wlfr Ret Charges Amount: $0
Wlfr Ret Oth Chrgs Amount: $0
Wlfr Ret Total Amount: $0
Wlfr Refund Amount: $0
Wlfr Held Bnfts Amount: $0
Wlfr Claims Reserve Amount: $0
Wlfr Oth Reserve Amount: $0
Wlfr Divnds Due Amount: $0
Wlfr Total Charges Paid Amount: $160,958
Wlfr Acquis Cost Amount: $0

Schedule C

Schedule C Provider

Provider 1

Provider details

Source fields

Row 1
Filing Id: 84037012089056
Page Id: 1
Page Seq: 0
Page Row Num: 1
Row Num: 0
Image Form Id: 4010376012089050004
Provider 01 Position: CONTRACT ADMINISTRATOR
Provider 01 Salary Amount: $0
Provider 01 Fees Amount: $0
Provider 01 Srvc Code: 12

Row 2
Filing Id: 84037012089056
Page Id: 3
Page Seq: 0
Page Row Num: 1
Row Num: 0
Image Form Id: 4010376012089050004

Schedule C Provider

Provider 2

Provider details

Source fields

Row 3
Filing Id: 84037012089056
Page Id: 1
Page Seq: 0
Page Row Num: 2
Row Num: 1
Image Form Id: 4010376012089050004
Provider 01 Name: CBSA
Provider 01 EIN: 41-1704028
Provider 01 Position: THIRD PARTY ADMINISTRATOR
Provider 01 Relation: NONE
Provider 01 Salary Amount: $0
Provider 01 Fees Amount: $28,573
Provider 01 Srvc Code: 13

Schedule C Provider

Provider 3

Provider details

Source fields

Row 4
Filing Id: 84037012089056
Schedule C EIN: 23-7363533
Schedule C Plan number: 501
Schedule C Plan Year Begin Date: 2004-05-01
Schedule C Tax Period: 20050430
Provider Total Comp Paid Amount: $33,481