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GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 401k Plan overview

Plan NameGROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE
Plan identification number 501

GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Other welfare benefit cover

401k Sponsoring company profile

CO GOS CO. has sponsored the creation of one or more 401k plans.

Company Name:CO GOS CO.
Employer identification number (EIN):251116726
NAIC Classification:445120
NAIC Description:Convenience Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-02-01JOHN EBY2019-09-12
5012017-02-01
5012016-02-01
5012015-02-01
5012014-02-01
5012013-02-01
5012012-02-01DAVID HEISLER
5012011-02-01DAVID HEISLER
5012009-02-01DAVID HEISLER

Plan Statistics for GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE

401k plan membership statisitcs for GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE

Measure Date Value
2018: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2018 401k membership
Total participants, beginning-of-year2018-02-01121
Total number of active participants reported on line 7a of the Form 55002018-02-010
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-010
2017: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2017 401k membership
Total participants, beginning-of-year2017-02-01100
Total number of active participants reported on line 7a of the Form 55002017-02-01121
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01121
Total participants2017-02-01121
2016: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2016 401k membership
Total participants, beginning-of-year2016-02-0195
Total number of active participants reported on line 7a of the Form 55002016-02-01100
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01100
Total participants2016-02-01100
2015: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2015 401k membership
Total participants, beginning-of-year2015-02-01102
Total number of active participants reported on line 7a of the Form 55002015-02-0195
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-0195
Total participants2015-02-0195
2014: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2014 401k membership
Total participants, beginning-of-year2014-02-0182
Total number of active participants reported on line 7a of the Form 55002014-02-01102
Number of retired or separated participants receiving benefits2014-02-010
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-01102
Total participants2014-02-01102
2013: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2013 401k membership
Total participants, beginning-of-year2013-02-0174
Total number of active participants reported on line 7a of the Form 55002013-02-0182
Number of retired or separated participants receiving benefits2013-02-010
Number of other retired or separated participants entitled to future benefits2013-02-010
Total of all active and inactive participants2013-02-0182
Total participants2013-02-0182
2012: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2012 401k membership
Total participants, beginning-of-year2012-02-0162
Total number of active participants reported on line 7a of the Form 55002012-02-0174
Number of retired or separated participants receiving benefits2012-02-010
Number of other retired or separated participants entitled to future benefits2012-02-010
Total of all active and inactive participants2012-02-0174
Total participants2012-02-0174
2011: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2011 401k membership
Total participants, beginning-of-year2011-02-0162
Total number of active participants reported on line 7a of the Form 55002011-02-0162
Number of retired or separated participants receiving benefits2011-02-010
Number of other retired or separated participants entitled to future benefits2011-02-010
Total of all active and inactive participants2011-02-0162
Total participants2011-02-0162
2009: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2009 401k membership
Total participants, beginning-of-year2009-02-0161
Total number of active participants reported on line 7a of the Form 55002009-02-0168
Number of retired or separated participants receiving benefits2009-02-010
Number of other retired or separated participants entitled to future benefits2009-02-010
Total of all active and inactive participants2009-02-0168
Total participants2009-02-0168

Form 5500 Responses for GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE

2018: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01This submission is the final filingYes
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2009: GROUP MEDICAL INSURANCE PLAN FOR FULL-TIME EMPLOYE 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01This submission is the final filingNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05357012
Policy instance 2
Insurance contract or identification numberTS05357012
Number of Individuals Covered121
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $5,048
Total amount of fees paid to insurance companyUSD $32
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,048
Amount paid for insurance broker fees32
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameSEUBERT & ASSOCIATES INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865858
Policy instance 1
Insurance contract or identification number0865858
Number of Individuals Covered98
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $18,581
Total amount of fees paid to insurance companyUSD $74
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $594,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,581
Amount paid for insurance broker fees74
Additional information about fees paid to insurance brokerINDIRECT COMPENSATION
Insurance broker organization code?3
Insurance broker nameSEUBERT & ASSOCIATES INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05357012
Policy instance 2
Insurance contract or identification numberTS05357012
Number of Individuals Covered66
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $4,606
Total amount of fees paid to insurance companyUSD $2,315
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,606
Amount paid for insurance broker fees17
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameLIAZON BENEFITS INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865858
Policy instance 1
Insurance contract or identification number0865858
Number of Individuals Covered95
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $15,986
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $519,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,986
Insurance broker organization code?3
Insurance broker nameSEUBERT & ASSOCIATES INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865858
Policy instance 1
Insurance contract or identification number0865858
Number of Individuals Covered102
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $14,463
Total amount of fees paid to insurance companyUSD $18
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $508,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,463
Amount paid for insurance broker fees18
Additional information about fees paid to insurance brokerADMIN FEES
Insurance broker organization code?3
Insurance broker nameSEUBERT & ASSOCIATES INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05357012
Policy instance 2
Insurance contract or identification numberTS05357012
Number of Individuals Covered68
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $3,850
Total amount of fees paid to insurance companyUSD $2,110
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,850
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMIN FEES
Insurance broker nameLIAZON BENEFITS INC
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number251548-000,-099
Policy instance 2
Insurance contract or identification number251548-000,-099
Number of Individuals Covered82
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $2,747
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,747
Insurance broker organization code?3
Insurance broker nameDDA INSURANCE MARKETS, LLC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01066800
Policy instance 1
Insurance contract or identification number01066800
Number of Individuals Covered70
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $18,132
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $477,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,961
Insurance broker organization code?3
Insurance broker nameBBR BENEFITS SOLUTIONS, LLC
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number251548-000,-099
Policy instance 2
Insurance contract or identification number251548-000,-099
Number of Individuals Covered74
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $2,288
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,288
Insurance broker organization code?3
Insurance broker nameDDA INSURANCE MARKETS, LLC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01469772
Policy instance 1
Insurance contract or identification number01469772
Number of Individuals Covered70
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $19,517
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $382,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,382
Insurance broker organization code?3
Insurance broker nameBBR BENEFITS SOLUTIONS, LLC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01469772
Policy instance 1
Insurance contract or identification number01469772
Number of Individuals Covered51
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $126
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number5924640000
Policy instance 2
Insurance contract or identification number5924640000
Number of Individuals Covered62
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $19,607
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $379,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number8072900
Policy instance 3
Insurance contract or identification number8072900
Number of Individuals Covered52
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameDDA INSURANCE MARKETS LLC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered62
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,725
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,725
Insurance broker organization code?3
Insurance broker nameDDA INSURANCE MARKETS LLC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract numberVARIOUS
Policy instance 2
Insurance contract or identification numberVARIOUS
Number of Individuals Covered62
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $6,598
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,598
Insurance broker organization code?3
Insurance broker nameDDA INSURANCE MARKETS LLC

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