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ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 401k Plan overview

Plan NameALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN
Plan identification number 501

ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN Benefits

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

401k Sponsoring company profile

ALBION INDUSTRIES INC. has sponsored the creation of one or more 401k plans.

Company Name:ALBION INDUSTRIES INC.
Employer identification number (EIN):363696184
NAIC Classification:332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012012-01-01CONNIE SKUNDRICH
5012011-01-01CONNIE SKUNDRICH
5012010-01-01CONNIE SKUNDRICH
5012009-01-01CONNIE SKUNDRICH

Plan Statistics for ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN

401k plan membership statisitcs for ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN

Measure Date Value
2012: ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0197
Total number of active participants reported on line 7a of the Form 55002012-01-01145
Total of all active and inactive participants2012-01-01145
Total participants2012-01-01145
2011: ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0198
Total number of active participants reported on line 7a of the Form 55002011-01-0197
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0197
Number of participants with account balances2011-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
Number of employers contributing to the scheme2011-01-010
2010: ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0190
Total number of active participants reported on line 7a of the Form 55002010-01-0198
Total of all active and inactive participants2010-01-0198
Total participants2010-01-0198
2009: ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01103
Total number of active participants reported on line 7a of the Form 55002009-01-0190
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0190
Total participants2009-01-0190

Form 5500 Responses for ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN

2012: ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: ALBION INDUSTRIES INC. MEDICAL EXPENSE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number82498495
Policy instance 3
Insurance contract or identification number82498495
Number of Individuals Covered57
Insurance policy start date2012-07-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $18,585
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $255,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,048
Insurance broker namePRITCHARD & JERDEN, INC.
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5451017
Policy instance 1
Insurance contract or identification number5451017
Number of Individuals Covered98
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,593
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,825
Insurance broker organization code?3
Amount paid for insurance broker fees3
Insurance broker namePRITCHARD & JERDEN INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9676123
Policy instance 2
Insurance contract or identification number9676123
Number of Individuals Covered91
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $554
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $325
Insurance broker nameLOCKTON COMPANIES, LLC - NY NY
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number113592
Policy instance 4
Insurance contract or identification number113592
Number of Individuals Covered145
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $32,378
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,503
Insurance broker organization code?3
Insurance broker nameAGENT ALLIANCE INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9676123
Policy instance 3
Insurance contract or identification number9676123
Number of Individuals Covered69
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $427
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5451017
Policy instance 2
Insurance contract or identification number5451017
Number of Individuals Covered95
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,211
Welfare Benefit Premiums Paid to CarrierUSD $63,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number82498495
Policy instance 1
Insurance contract or identification number82498495
Number of Individuals Covered38
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $12,207
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $176,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number05913-979
Policy instance 4
Insurance contract or identification number05913-979
Number of Individuals Covered142
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5451017
Policy instance 4
Insurance contract or identification number5451017
Number of Individuals Covered96
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,828
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,828
Insurance broker organization code?3
Insurance broker namePRITCHARD & JERDEN, INC
SHENANDOAH LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0070045482
Policy instance 5
Insurance contract or identification number0070045482
Number of Individuals Covered32
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $431
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $431
Insurance broker namePRITCHARD & JERDEN, INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9676123
Policy instance 2
Insurance contract or identification number9676123
Number of Individuals Covered61
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $387
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $387
Insurance broker namePRITCHARD & JERDEN INC
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number05913-979
Policy instance 1
Insurance contract or identification number05913-979
Number of Individuals Covered145
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number82498495
Policy instance 3
Insurance contract or identification number82498495
Number of Individuals Covered34
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $9,447
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $160,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,447
Insurance broker namePRITCHARD & JERDEN, INC

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