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| Plan Name | LIFE INSURANCE |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | AMERICAN DISH SERVICE |
| Employer identification number (EIN): | 431031331 |
| NAIC Classification: | 333310 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2018-01-01 | MICHELLE HATFIELD | |||
| 501 | 2017-01-01 | MICHELLE HATFIELD | |||
| 501 | 2016-01-01 | MICHELLE HATFIELD |
| Measure | Date | Value |
|---|---|---|
| 2018: LIFE INSURANCE 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 113 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 113 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 113 |
| 2017: LIFE INSURANCE 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 121 |
| Total of all active and inactive participants | 2017-01-01 | 121 |
| Total participants | 2017-01-01 | 121 |
| 2016: LIFE INSURANCE 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 101 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 101 |
| Total participants | 2016-01-01 | 101 |
| 2018: LIFE INSURANCE 2018 form 5500 responses | ||
|---|---|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: LIFE INSURANCE 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: LIFE INSURANCE 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | First time form 5500 has been submitted | Yes |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 50006951 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 500006951 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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