401k Plan data: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN plan

KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 401k Plan overview

Plan Name	KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN
Plan identification number	550

KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

KOSS CONSTRUCTION COMPANY has sponsored the creation of one or more 401k plans.

Company Name: KOSS CONSTRUCTION COMPANY

Employer identification number (EIN): 420364440

NAIC Classification: 237310
NAIC Description: Highway, Street, and Bridge Construction

Additional information about KOSS CONSTRUCTION COMPANY

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities

Incorporation Date: 1914-02-11

Company Identification Number: 023472

Legal Registered Office Address: 505 5TH AVE STE 729

DES MOINES
United States of America (USA)
50309

More information about KOSS CONSTRUCTION COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
550 2015-01-01 ALLEN PAYNE
550 2014-01-01 ALLEN PAYNE
550 2013-01-01 ALLEN PAYNE DAVID M. HOWARD 2014-07-31
550 2012-08-01 ALLEN PAYNE DAVID M HOWARD 2013-07-26
550 2006-08-01 ALLEN PAYNE DAVID M HOWARD 2012-12-05

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
550	2015-01-01	ALLEN PAYNE
550	2014-01-01	ALLEN PAYNE
550	2013-01-01	ALLEN PAYNE	DAVID M. HOWARD	2014-07-31
550	2012-08-01	ALLEN PAYNE	DAVID M HOWARD	2013-07-26
550	2006-08-01	ALLEN PAYNE	DAVID M HOWARD	2012-12-05

Plan Statistics for KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN

401k plan membership statisitcs for KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN

Measure Date Value
2015: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 128
Number of retired or separated participants receiving benefits 2015-01-01 6
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 134
2014: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 126
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 128
2013: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 131
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 133
2012: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-08-01 123
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 126
Number of retired or separated participants receiving benefits 2012-08-01 0
Number of other retired or separated participants entitled to future benefits 2012-08-01 0
Total of all active and inactive participants 2012-08-01 126
2006: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2006 401k membership
Total participants, beginning-of-year 2006-08-01 254
Total number of active participants reported on line 7a of the Form 5500 2006-08-01 245
Number of retired or separated participants receiving benefits 2006-08-01 3
Number of other retired or separated participants entitled to future benefits 2006-08-01 0
Total of all active and inactive participants 2006-08-01 248

Measure	Date	Value
2015: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	128
Number of retired or separated participants receiving benefits	2015-01-01	6
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	134
2014: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	126
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	128
2013: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	131
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	133
2012: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-08-01	123
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	126
Number of retired or separated participants receiving benefits	2012-08-01	0
Number of other retired or separated participants entitled to future benefits	2012-08-01	0
Total of all active and inactive participants	2012-08-01	126
2006: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2006 401k membership
Total participants, beginning-of-year	2006-08-01	254
Total number of active participants reported on line 7a of the Form 5500	2006-08-01	245
Number of retired or separated participants receiving benefits	2006-08-01	3
Number of other retired or separated participants entitled to future benefits	2006-08-01	0
Total of all active and inactive participants	2006-08-01	248

Form 5500 Responses for KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN

2015: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Submission has been amended	No
2012-08-01	This submission is the final filing	No
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-08-01	Plan is a collectively bargained plan	No
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2006: KOSS CONSTRUCTION COMPANY GROUP MEDICAL PLAN 2006 form 5500 responses
2006-08-01	Type of plan entity	Single employer plan
2006-08-01	Submission has been amended	Yes
2006-08-01	This submission is the final filing	No
2006-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-08-01	Plan is a collectively bargained plan	No
2006-08-01	Plan funding arrangement – Insurance	Yes
2006-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5474770

Policy instance

Insurance contract or identification number	5474770
Number of Individuals Covered	38
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,872
Total amount of fees paid to insurance company	USD $768
Other welfare benefits provided	ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $12,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,872
Amount paid for insurance broker fees	768
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	BUKATY COMPANIES

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

09451

Policy instance

Insurance contract or identification number	09451
Number of Individuals Covered	291
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )

Policy contract number

5051610000

Policy instance

Insurance contract or identification number	5051610000
Number of Individuals Covered	300
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $75,718
Total amount of fees paid to insurance company	USD $116
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,514,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75,718
Amount paid for insurance broker fees	116
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF GREATER KANSAS

CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )

Policy contract number

5051610000

Policy instance

Insurance contract or identification number	5051610000
Number of Individuals Covered	319
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $72,187
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,443,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,187
Insurance broker organization code?	3
Insurance broker name	WILLIS OF GREATER KANSAS

CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )

Policy contract number

5051610000

Policy instance

Insurance contract or identification number	5051610000
Number of Individuals Covered	302
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $64,312
Total amount of fees paid to insurance company	USD $28,695
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,286,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,312
Amount paid for insurance broker fees	28695
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF GREATER KANSAS

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

07488

Policy instance

Insurance contract or identification number	07488
Number of Individuals Covered	245
Insurance policy start date	2006-08-01
Insurance policy end date	2007-07-31
Total amount of commissions paid to insurance broker	USD $13,066
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	KOSS CONSTRUCTION COMPANY
Employer identification number (EIN):	420364440
NAIC Classification:	237310
NAIC Description:	Highway, Street, and Bridge Construction

Jurisdiction of Incorporation:	Iowa Secretary of State Business Entities
Incorporation Date:	1914-02-11
Company Identification Number:	023472
Legal Registered Office Address:	505 5TH AVE STE 729 DES MOINES United States of America (USA) 50309