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SOURCE MANAGEMENT INC GROUP MEDICAL PLAN 401k Plan overview

Plan NameSOURCE MANAGEMENT INC GROUP MEDICAL PLAN
Plan identification number 501

SOURCE MANAGEMENT INC GROUP MEDICAL PLAN Benefits

401k Plan TypeWelfare 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.

401k Sponsoring company profile

SOURCE MANAGEMENT INC has sponsored the creation of one or more 401k plans.

Company Name:SOURCE MANAGEMENT INC
Employer identification number (EIN):841151197
NAIC Classification:453210
NAIC Description:Office Supplies and Stationery Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOURCE MANAGEMENT INC GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-06-01BRIANNA FERRAN
5012015-06-01BRIANNA FERRAN
5012014-06-012016-01-20
5012014-06-01JEFF GOERGEN JEFF GOERGEN2016-01-20

Plan Statistics for SOURCE MANAGEMENT INC GROUP MEDICAL PLAN

401k plan membership statisitcs for SOURCE MANAGEMENT INC GROUP MEDICAL PLAN

Measure Date Value
2016: SOURCE MANAGEMENT INC GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01117
Total number of active participants reported on line 7a of the Form 55002016-06-0177
Number of retired or separated participants receiving benefits2016-06-010
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-0177
2015: SOURCE MANAGEMENT INC GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01130
Total number of active participants reported on line 7a of the Form 55002015-06-01117
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01117
2014: SOURCE MANAGEMENT INC GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01130
Total number of active participants reported on line 7a of the Form 55002014-06-01130
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01130

Form 5500 Responses for SOURCE MANAGEMENT INC GROUP MEDICAL PLAN

2016: SOURCE MANAGEMENT INC GROUP MEDICAL PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: SOURCE MANAGEMENT INC GROUP MEDICAL PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: SOURCE MANAGEMENT INC GROUP MEDICAL PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedYes
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0803249
Policy instance 1
Insurance contract or identification number0803249
Number of Individuals Covered117
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $26,391
Total amount of fees paid to insurance companyUSD $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 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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $525,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,391
Insurance broker organization code?3
Insurance broker nameCOBIZ INSURANCE
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0803249
Policy instance 1
Insurance contract or identification number0803249
Number of Individuals Covered130
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $23,884
Total amount of fees paid to insurance companyUSD $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 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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
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
Welfare Benefit Premiums Paid to CarrierUSD $734,580
Commission paid to Insurance BrokerUSD $23,884
Insurance broker organization code?3
Insurance broker nameCOBIZ INSURANCE

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