CHAMPION EMS has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2016: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 197 |
| Total of all active and inactive participants | 2016-05-01 | 0 |
| Total participants | 2016-05-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 195 |
| 2015: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 468 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 195 |
| Number of retired or separated participants receiving benefits | 2015-05-01 | 2 |
| Total of all active and inactive participants | 2015-05-01 | 197 |
| Total participants | 2015-05-01 | 0 |
| 2014: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 493 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 468 |
| Total of all active and inactive participants | 2014-05-01 | 468 |
| Total participants | 2014-05-01 | 0 |
| 2013: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 509 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 491 |
| Number of retired or separated participants receiving benefits | 2013-05-01 | 2 |
| Total of all active and inactive participants | 2013-05-01 | 493 |
| Total participants | 2013-05-01 | 0 |
| 2012: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 216 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 214 |
| Number of retired or separated participants receiving benefits | 2012-05-01 | 1 |
| Total of all active and inactive participants | 2012-05-01 | 215 |
| Total participants | 2012-05-01 | 0 |
| 2011: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 216 |
| Total of all active and inactive participants | 2011-05-01 | 216 |
| Total participants | 2011-05-01 | 216 |
| 2016: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | This submission is the final filing | Yes |
| 2016-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-05-01 | Plan funding arrangement – Insurance | Yes |
| 2016-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | First time form 5500 has been submitted | Yes |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| INTERNATIONAL ASSURANCE OF TN, INC. (National Association of Insurance Commissioners NAIC id number: 68039 ) |
| Policy contract number | IAT-SA0165 |
| Policy instance | 1 |
| Insurance contract or identification number | IAT-SA0165 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of fees paid to insurance company | USD $96,800 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 96800 | | Additional information about fees paid to insurance broker | CONSULTANT FEES | | Insurance broker organization code? | 3 | | Insurance broker name | BOSWORTH & ASSOCIATES |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 076811 |
| Policy instance | 1 |
| Insurance contract or identification number | 076811 | | Number of Individuals Covered | 468 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $106,847 | | Total amount of fees paid to insurance company | USD $2,400 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,148,281 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $106,847 | | Amount paid for insurance broker fees | 2400 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | BOSWORTH & ASSOCIATES |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 076811 |
| Policy instance | 1 |
| Insurance contract or identification number | 076811 | | Number of Individuals Covered | 491 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $103,045 | | Total amount of fees paid to insurance company | USD $3,008 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,253,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $103,045 | | Amount paid for insurance broker fees | 3008 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | BOSWORTH & ASSOCIATES |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 076811 |
| Policy instance | 1 |
| Insurance contract or identification number | 076811 | | Number of Individuals Covered | 509 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $104,391 | | Total amount of fees paid to insurance company | USD $4,643 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,020,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $104,391 | | Amount paid for insurance broker fees | 4643 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | BOSWORTH & ASSOCIATES |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 076811 |
| Policy instance | 1 |
| Insurance contract or identification number | 076811 | | Number of Individuals Covered | 487 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $97,758 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,908,764 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
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