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GROUP TERM LIFE GROUP AD&D 401k Plan overview

Plan NameGROUP TERM LIFE GROUP AD&D
Plan identification number 504

GROUP TERM LIFE GROUP AD&D Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

SERVUS, INC. has sponsored the creation of one or more 401k plans.

Company Name:SERVUS, INC.
Employer identification number (EIN):351279978
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP TERM LIFE GROUP AD&D

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042018-02-01KRISTI MEHRINGER KRISTI MEHRINGER2019-07-25
5042017-02-01JASON KELLY JASON KELLY2018-07-26
5042016-02-01JASON KELLY JASON KELLY2017-10-13
5042015-02-01JASON KELLY JASON KELLY2016-07-20
5042014-02-01JASON KELLY JASON KELLY2015-07-15
5042013-02-01JASON KELLY JASON KELLY2014-06-26
5042012-02-01JASON KELLY JASON KELLY2013-07-11
5042011-02-01JASON KELLY JASON KELLY2012-07-18
5042010-02-01JASON KELLY JASON KELLY2011-07-11
5042009-02-01JASON KELLY JASON KELLY2010-07-26

Plan Statistics for GROUP TERM LIFE GROUP AD&D

401k plan membership statisitcs for GROUP TERM LIFE GROUP AD&D

Measure Date Value
2018: GROUP TERM LIFE GROUP AD&D 2018 401k membership
Total participants, beginning-of-year2018-02-01311
Total number of active participants reported on line 7a of the Form 55002018-02-0190
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 participants2018-02-0190
2017: GROUP TERM LIFE GROUP AD&D 2017 401k membership
Total participants, beginning-of-year2017-02-01129
Total number of active participants reported on line 7a of the Form 55002017-02-01311
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 participants2017-02-01311
2016: GROUP TERM LIFE GROUP AD&D 2016 401k membership
Total participants, beginning-of-year2016-02-01368
Total number of active participants reported on line 7a of the Form 55002016-02-01129
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 participants2016-02-01129
2015: GROUP TERM LIFE GROUP AD&D 2015 401k membership
Total participants, beginning-of-year2015-02-01414
Total number of active participants reported on line 7a of the Form 55002015-02-01368
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 participants2015-02-01368
2014: GROUP TERM LIFE GROUP AD&D 2014 401k membership
Total participants, beginning-of-year2014-02-01510
Total number of active participants reported on line 7a of the Form 55002014-02-01414
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 participants2014-02-01414
2013: GROUP TERM LIFE GROUP AD&D 2013 401k membership
Total participants, beginning-of-year2013-02-01545
Total number of active participants reported on line 7a of the Form 55002013-02-01510
Total of all active and inactive participants2013-02-01510
2012: GROUP TERM LIFE GROUP AD&D 2012 401k membership
Total participants, beginning-of-year2012-02-01483
Total number of active participants reported on line 7a of the Form 55002012-02-01545
Total of all active and inactive participants2012-02-01545
2011: GROUP TERM LIFE GROUP AD&D 2011 401k membership
Total participants, beginning-of-year2011-02-01417
Total number of active participants reported on line 7a of the Form 55002011-02-01483
Total of all active and inactive participants2011-02-01483
2010: GROUP TERM LIFE GROUP AD&D 2010 401k membership
Total participants, beginning-of-year2010-02-01433
Total number of active participants reported on line 7a of the Form 55002010-02-01417
Total of all active and inactive participants2010-02-01417
2009: GROUP TERM LIFE GROUP AD&D 2009 401k membership
Total participants, beginning-of-year2009-02-01440
Total number of active participants reported on line 7a of the Form 55002009-02-01433
Total of all active and inactive participants2009-02-01433

Form 5500 Responses for GROUP TERM LIFE GROUP AD&D

2018: GROUP TERM LIFE GROUP AD&D 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: GROUP TERM LIFE GROUP AD&D 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 TERM LIFE GROUP AD&D 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 TERM LIFE GROUP AD&D 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 TERM LIFE GROUP AD&D 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 TERM LIFE GROUP AD&D 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Submission has been amendedYes
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: GROUP TERM LIFE GROUP AD&D 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 TERM LIFE GROUP AD&D 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2010: GROUP TERM LIFE GROUP AD&D 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan benefit arrangement – InsuranceYes
2009: GROUP TERM LIFE GROUP AD&D 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000 23
Policy instance 1
Insurance contract or identification number000400001000 23
Number of Individuals Covered90
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,557
Total amount of fees paid to insurance companyUSD $1,128
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,557
Amount paid for insurance broker fees1128
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016264-00
Policy instance 1
Insurance contract or identification number01-016264-00
Number of Individuals Covered311
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,236
Total amount of fees paid to insurance companyUSD $975
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,236
Amount paid for insurance broker fees975
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameJA BENEFITS LLC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016264-00
Policy instance 1
Insurance contract or identification number01-016264-00
Number of Individuals Covered368
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $6,032
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $23,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,032
Insurance broker organization code?3
Insurance broker nameJA BENEFITS LLC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016264-00
Policy instance 1
Insurance contract or identification number01-016264-00
Number of Individuals Covered414
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $3,343
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $22,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,343
Insurance broker organization code?3
Insurance broker nameJA BENEFITS LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 961880
Policy instance 1
Insurance contract or identification numberOK 961880
Number of Individuals Covered510
Insurance policy start date2012-03-01
Insurance policy end date2013-03-01
Total amount of commissions paid to insurance brokerUSD $1,187
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,187
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
Insurance broker nameASSURED PARTNERS OF INDIANA
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 961880
Policy instance 1
Insurance contract or identification numberOK 961880
Number of Individuals Covered545
Insurance policy start date2011-03-01
Insurance policy end date2012-03-01
Total amount of commissions paid to insurance brokerUSD $1,257
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,257
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
Insurance broker nameTOBIAS INSURANCE GROUP
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 961880
Policy instance 1
Insurance contract or identification numberOK 961880
Number of Individuals Covered483
Insurance policy start date2010-03-01
Insurance policy end date2011-03-01
Total amount of commissions paid to insurance brokerUSD $1,112
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 961880
Policy instance 1
Insurance contract or identification numberOK 961880
Number of Individuals Covered417
Insurance policy start date2009-03-01
Insurance policy end date2010-03-01
Total amount of commissions paid to insurance brokerUSD $1,521
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,521
Additional information about fees paid to insurance brokerSALES SERVICE
Insurance broker organization code?3
Insurance broker nameTOBIAS INSURANCE GROUP

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