| Plan Name | PART-TIME MEDICAL |
| Plan identification number | 508 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | SERVUS, INC. |
| Employer identification number (EIN): | 351279978 |
| NAIC Classification: | 722511 |
| NAIC Description: | Full-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 508 | 2017-10-01 | ||||
| 508 | 2016-10-01 | JASON KELLY | JASON KELLY | 2017-12-12 | |
| 508 | 2015-10-01 | JASON KELLY | JASON KELLY | 2017-05-01 | |
| 508 | 2014-10-01 | JASON KELLY | JASON KELLY | 2016-05-02 | |
| 508 | 2013-10-01 | JASON KELLY | JASON KELLY | 2015-07-15 | |
| 508 | 2012-10-01 | JASON KELLY | JASON KELLY | 2014-06-26 | |
| 508 | 2011-10-01 | JASON KELLY | JASON KELLY | 2013-04-29 | |
| 508 | 2009-10-01 | JASON KELLY | JASON KELLY | 2011-07-11 |
| 2017: PART-TIME MEDICAL 2017 form 5500 responses | ||
|---|---|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: PART-TIME MEDICAL 2016 form 5500 responses | ||
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: PART-TIME MEDICAL 2015 form 5500 responses | ||
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: PART-TIME MEDICAL 2014 form 5500 responses | ||
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: PART-TIME MEDICAL 2013 form 5500 responses | ||
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: PART-TIME MEDICAL 2012 form 5500 responses | ||
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: PART-TIME MEDICAL 2011 form 5500 responses | ||
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: PART-TIME MEDICAL 2009 form 5500 responses | ||
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 ) | |
| Policy contract number | 8475395 |
| Policy instance | 1 |