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MEDIUSA MEDICAL PLAN 401k Plan overview

Plan NameMEDIUSA MEDICAL PLAN
Plan identification number 501

MEDIUSA MEDICAL PLAN Benefits

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

401k Sponsoring company profile

MEDI USA, L.P. has sponsored the creation of one or more 401k plans.

Company Name:MEDI USA, L.P.
Employer identification number (EIN):363615477
NAIC Classification:315100
NAIC Description: Apparel Knitting Mills

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDIUSA MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012012-01-01TIMOTHY HORKEY TIMOTHY HORKEY2013-07-25
5012011-01-01TIMOTHY HORKEY TIMOTHY HORKEY2013-07-25
5012009-01-01TIMOTHY HORKEY TIMOTHY HORKEY2013-07-25
5012008-01-01TIMOTHY HORKEY TIMOTHY HORKEY2013-07-25
5012007-01-01TIMOTHY HORKEY TIMOTHY HORKEY2013-07-25
5012006-01-01TIMOTHY HORKEY TIMOTHY HORKEY2013-07-25

Plan Statistics for MEDIUSA MEDICAL PLAN

401k plan membership statisitcs for MEDIUSA MEDICAL PLAN

Measure Date Value
2012: MEDIUSA MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01103
Total number of active participants reported on line 7a of the Form 55002012-01-010
Total of all active and inactive participants2012-01-010
Total participants2012-01-010
2011: MEDIUSA MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01154
Total number of active participants reported on line 7a of the Form 55002011-01-01103
Total of all active and inactive participants2011-01-01103
Total participants2011-01-01103
2009: MEDIUSA MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01141
Total number of active participants reported on line 7a of the Form 55002009-01-01131
Total of all active and inactive participants2009-01-01131
Total participants2009-01-01131
2008: MEDIUSA MEDICAL PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01120
Total number of active participants reported on line 7a of the Form 55002008-01-01141
Total of all active and inactive participants2008-01-01141
Total participants2008-01-01141
2007: MEDIUSA MEDICAL PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01126
Total number of active participants reported on line 7a of the Form 55002007-01-01120
Total of all active and inactive participants2007-01-01120
Total participants2007-01-01120
2006: MEDIUSA MEDICAL PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01126
Total number of active participants reported on line 7a of the Form 55002006-01-01126
Total of all active and inactive participants2006-01-01126
Total participants2006-01-01126

Form 5500 Responses for MEDIUSA MEDICAL PLAN

2012: MEDIUSA MEDICAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingYes
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MEDIUSA MEDICAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: MEDIUSA MEDICAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: MEDIUSA MEDICAL PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: MEDIUSA MEDICAL PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – InsuranceYes
2006: MEDIUSA MEDICAL PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01First time form 5500 has been submittedYes
2006-01-01Submission has been amendedNo
2006-01-01This submission is the final filingNo
2006-01-01This return/report is a short plan year return/report (less than 12 months)No
2006-01-01Plan is a collectively bargained planNo
2006-01-01Plan funding arrangement – InsuranceYes
2006-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number070559
Policy instance 1
Insurance contract or identification number070559
Number of Individuals Covered256
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,214,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameBLAKE V WELLER
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number070559
Policy instance 1
Insurance contract or identification number070559
Number of Individuals Covered246
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,594
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,215,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number070558
Policy instance 1
Insurance contract or identification number070558
Number of Individuals Covered95
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $382,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number070559
Policy instance 2
Insurance contract or identification number070559
Number of Individuals Covered204
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $770,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number131040
Policy instance 1
Insurance contract or identification number131040
Number of Individuals Covered141
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number131040
Policy instance 1
Insurance contract or identification number131040
Number of Individuals Covered120
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number131040
Policy instance 1
Insurance contract or identification number131040
Number of Individuals Covered126
Insurance policy start date2006-01-01
Insurance policy end date2006-12-31
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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