Filing

Genesis Development Employee Medical Benefit Plan

Genesis Development • EIN 23-7363533 • Plan year 2007

Company Profile Source Archive

Filing Insights

Participants

148 → 180

32 • 21.62%

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	Current	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	-	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: 91037043093039
Form Id: 94720967
Page Id: 2
Page Seq: 0
Page Row Num: 1
Row Num: 0
Image Form Id: 7020379026523030003
Ins Broker 01 Name: MERITAIN HEALTH
Ins Broker 01 Street Addr: 400 HIGHWAY 169 SOUTH SUITE 800
Ins Broker 01 City: MINNEAPOLIS
Ins Broker 01 State: IA
Ins Broker 01 ZIP Code: 554261141
Ins Broker Comm Pd 01 Amount: $1,373
Ins Broker Fees Pd 01 Amount: $0
Ins Broker 01 Code: 3

Row 2
Filing Id: 91037043093039
Form Id: 94720966
Page Id: 2
Page Seq: 0
Page Row Num: 1
Row Num: 0
Image Form Id: 7020379026523030002
Ins Broker 01 Name: CBSA
Ins Broker 01 Street Addr: 10159 WAYZATA BLVD
Ins Broker 01 City: MINNETONKA
Ins Broker 01 State: MN
Ins Broker 01 ZIP Code: 553051503
Ins Broker Comm Pd 01 Amount: $44,082
Ins Broker Fees Pd 01 Amount: $0
Ins Broker 01 Code: 5

Row 3
Filing Id: 91037043093039
Form Id: 94720966
Page Id: 2
Page Seq: 0
Page Row Num: 2
Row Num: 1
Image Form Id: 7020379026523030002
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: $11,174
Ins Broker Fees Pd 01 Amount: $0
Ins Broker 01 Code: 3

Row 4
Filing Id: 91037043093039
Form Id: 94720967
Page Id: 2
Page Seq: 0
Page Row Num: 2
Row Num: 1
Image Form Id: 7020379026523030003
Ins Broker 01 Name: CBSA
Ins Broker 01 Street Addr: 10159 WAYZATA BLVD
Ins Broker 01 City: MINNETONKA
Ins Broker 01 State: MN
Ins Broker 01 ZIP Code: 55305
Ins Broker Comm Pd 01 Amount: $610
Ins Broker Fees Pd 01 Amount: $0
Ins Broker 01 Code: 5

Row 5
Filing Id: 91037043093039
Form Id: 94720967
Page Id: 2
Page Seq: 0
Page Row Num: 3
Row Num: 2
Image Form Id: 7020379026523030003
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: $407
Ins Broker Fees Pd 01 Amount: $0
Ins Broker 01 Code: 3

Row 6: Ins Carrier Name: AMERICAN UNITED LIFE
Filing Id: 91037043093039
Form Id: 94720966
Schedule A EIN: 23-7363533
Schedule A Plan Num: 501
Schedule A Plan Year Begin Date: 2007-05-01
Schedule A Tax Period: 20080430
Ins Carrier Name: AMERICAN UNITED LIFE
Ins Carrier EIN: 16-1264154
Ins Carrier Naic Code: 95487
Ins Contract Num: 50109001855
Ins Prsn Covered End of year Count: 145
Ins Broker Comm Total Amount: $55,256
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: $151,614
Wlfr Acquis Cost Amount: $0

Row 7: Ins Carrier Name: LINCOLN NATIONAL LIFE INSURANCE COMPANY
Filing Id: 91037043093039
Form Id: 94720967
Schedule A EIN: 23-7363533
Schedule A Plan Num: 501
Schedule A Plan Year Begin Date: 2007-05-01
Schedule A Tax Period: 20080430
Ins Carrier Name: LINCOLN NATIONAL LIFE INSURANCE COMPANY
Ins Carrier EIN: 35-0472300
Ins Carrier Naic Code: 70254
Ins Contract Num: 000010017564
Ins Prsn Covered End of year Count: 180
Ins Broker Comm Total Amount: $2,390
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: $4,068
Wlfr Acquis Cost Amount: $0

Schedule C

Schedule C Provider

Provider 1

Provider details

Source fields

Row 1
Filing Id: 91037043093039
Page Id: 1
Page Seq: 0
Page Row Num: 1
Row Num: 0
Image Form Id: 7020379026523030004
Provider 01 Name: CBSA
Provider 01 EIN: 41-1704028
Provider 01 Position: CONTRACT ADMINISTRATOR
Provider 01 Relation: NONE
Provider 01 Salary Amount: $0
Provider 01 Fees Amount: $44,692
Provider 01 Srvc Code: 12

Row 2
Filing Id: 91037043093039
Page Id: 3
Page Seq: 0
Page Row Num: 1
Row Num: 0
Image Form Id: 7020379026523030004

Schedule C Provider

Provider 2

Provider details

Source fields

Row 3
Filing Id: 91037043093039
Page Id: 1
Page Seq: 0
Page Row Num: 2
Row Num: 1
Image Form Id: 7020379026523030004
Provider 01 Name: MIDLANDS CHOICE
Provider 01 EIN: 47-0696044
Provider 01 Position: PPO
Provider 01 Relation: NONE
Provider 01 Salary Amount: $0
Provider 01 Fees Amount: $6,970
Provider 01 Srvc Code: 30

Schedule C Provider

Provider 3

Provider details

Source fields

Row 4
Filing Id: 91037043093039
Schedule C EIN: 23-7363533
Schedule C Plan number: 501
Schedule C Plan Year Begin Date: 2007-05-01
Schedule C Tax Period: 20080430
Provider Total Comp Paid Amount: $0