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POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE 401k Plan overview

Plan NamePOTTLES TRANSPORTATION GROUP MEDICAL INSURANCE
Plan identification number 501

POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

POTTLES TRANSPORTATION LLC has sponsored the creation of one or more 401k plans.

Company Name:POTTLES TRANSPORTATION LLC
Employer identification number (EIN):274982626
NAIC Classification:484120
NAIC Description: General Freight Trucking, Long-Distance

Form 5500 Filing Information

Submission information for form 5500 for 401k plan POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-09-01DUANE GRAVES
5012014-09-01DUANE GRAVES DUANE GRAVES2015-10-01
5012013-09-01DUANE GRAVES DUANE GRAVES2015-10-01

Plan Statistics for POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE

401k plan membership statisitcs for POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE

Measure Date Value
2015: POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-09-01113
Total number of active participants reported on line 7a of the Form 55002015-09-01117
Total of all active and inactive participants2015-09-01117
Total participants2015-09-01117
2014: POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-09-01104
Total number of active participants reported on line 7a of the Form 55002014-09-01113
Total of all active and inactive participants2014-09-01113
Total participants2014-09-01113
2013: POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-09-01100
Total number of active participants reported on line 7a of the Form 55002013-09-01104
Total of all active and inactive participants2013-09-01104
Total participants2013-09-01104
Number of employers contributing to the scheme2013-09-011

Form 5500 Responses for POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE

2015: POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Submission has been amendedNo
2014-09-01This submission is the final filingNo
2014-09-01This return/report is a short plan year return/report (less than 12 months)No
2014-09-01Plan is a collectively bargained planNo
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: POTTLES TRANSPORTATION GROUP MEDICAL INSURANCE 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01First time form 5500 has been submittedYes
2013-09-01Submission has been amendedNo
2013-09-01This submission is the final filingNo
2013-09-01This return/report is a short plan year return/report (less than 12 months)No
2013-09-01Plan is a collectively bargained planNo
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ANTHEM HEALTH PLANS OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 52618 )
Policy contract number
Policy instance 1
Number of Individuals Covered117
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $30,873
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,873
Insurance broker nameWOODROW W CROSS
MAINE WELLNESS ASSOCIATION CAPTIVE, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 1
Number of Individuals Covered114
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $17,920
Total amount of fees paid to insurance companyUSD $17,920
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,920
Insurance broker nameCROSS INSURANCE
MAINE WELLNESS ASSOCIATION CAPTIVE, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 1
Number of Individuals Covered104
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $25,760
Total amount of fees paid to insurance companyUSD $25,760
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,760
Insurance broker nameCROSS INSURANCE

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