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ADAIR COUNTY AMBULANCE DISTRICT 401k Plan overview

Plan NameADAIR COUNTY AMBULANCE DISTRICT
Plan identification number 530

ADAIR COUNTY AMBULANCE DISTRICT Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

ADAIR COUNTY AMBULANCE DISTRICT has sponsored the creation of one or more 401k plans.

Company Name:ADAIR COUNTY AMBULANCE DISTRICT
Employer identification number (EIN):431352323
NAIC Classification:921000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADAIR COUNTY AMBULANCE DISTRICT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5302016-11-01HEATHER CRAIG
5302015-11-01HEATHER CRAIG
5302014-11-01HEATHER CRAIG
5302013-11-01HEATHER CRAIG
5302012-11-01DANA MACKENZIE

Plan Statistics for ADAIR COUNTY AMBULANCE DISTRICT

401k plan membership statisitcs for ADAIR COUNTY AMBULANCE DISTRICT

Measure Date Value
2016: ADAIR COUNTY AMBULANCE DISTRICT 2016 401k membership
Total participants, beginning-of-year2016-11-0136
Total number of active participants reported on line 7a of the Form 55002016-11-0136
Total of all active and inactive participants2016-11-0136
Total participants2016-11-0136
2015: ADAIR COUNTY AMBULANCE DISTRICT 2015 401k membership
Total participants, beginning-of-year2015-11-0133
Total number of active participants reported on line 7a of the Form 55002015-11-0137
Total of all active and inactive participants2015-11-0137
Total participants2015-11-0137
2014: ADAIR COUNTY AMBULANCE DISTRICT 2014 401k membership
Total participants, beginning-of-year2014-11-012
Total number of active participants reported on line 7a of the Form 55002014-11-0136
Total of all active and inactive participants2014-11-0136
Total participants2014-11-0136
2013: ADAIR COUNTY AMBULANCE DISTRICT 2013 401k membership
Total participants, beginning-of-year2013-11-0127
Total number of active participants reported on line 7a of the Form 55002013-11-0129
Number of retired or separated participants receiving benefits2013-11-010
Number of other retired or separated participants entitled to future benefits2013-11-010
Total of all active and inactive participants2013-11-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-11-010
Total participants2013-11-0129
2012: ADAIR COUNTY AMBULANCE DISTRICT 2012 401k membership
Total participants, beginning-of-year2012-11-0117
Total number of active participants reported on line 7a of the Form 55002012-11-0121
Number of retired or separated participants receiving benefits2012-11-010
Number of other retired or separated participants entitled to future benefits2012-11-010
Total of all active and inactive participants2012-11-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-11-010
Total participants2012-11-0121

Form 5500 Responses for ADAIR COUNTY AMBULANCE DISTRICT

2016: ADAIR COUNTY AMBULANCE DISTRICT 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – General assets of the sponsorYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – General assets of the sponsorYes
2015: ADAIR COUNTY AMBULANCE DISTRICT 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – General assets of the sponsorYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – General assets of the sponsorYes
2014: ADAIR COUNTY AMBULANCE DISTRICT 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – General assets of the sponsorYes
2014-11-01Plan benefit arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – General assets of the sponsorYes
2013: ADAIR COUNTY AMBULANCE DISTRICT 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01First time form 5500 has been submittedYes
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan funding arrangement – General assets of the sponsorYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – General assets of the sponsorYes
2012: ADAIR COUNTY AMBULANCE DISTRICT 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01First time form 5500 has been submittedYes
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan funding arrangement – General assets of the sponsorYes
2012-11-01Plan benefit arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract numberECU-0118-GL-2
Policy instance 1
Insurance contract or identification numberECU-0118-GL-2
Number of Individuals Covered36
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $15,422
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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
Other information about contractSTOP LOSS
Commission paid to Insurance BrokerUSD $10,280
Insurance broker organization code?3
Insurance broker nameGROUP BENEFIT SERVICES, INC.
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number
Policy instance 1
Number of Individuals Covered29
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $8,658
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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
Other information about contractSTOP LOSS
Commission paid to Insurance BrokerUSD $5,772
Insurance broker organization code?3
Insurance broker nameGROUP BENEFIT SERVICES, INC.
JOHN ALDEN / ASSURANT HEALTH (National Association of Insurance Commissioners NAIC id number: )
Policy contract number162544
Policy instance 1
Insurance contract or identification number162544
Number of Individuals Covered21
Insurance policy start date2012-11-01
Insurance policy end date2013-10-30
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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
Other information about contractGROUP POLICY

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