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BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 401k Plan overview

Plan NameBASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE
Plan identification number 501

BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Other welfare benefit cover

401k Sponsoring company profile

PATHOLOGY MEDICAL SERVICES, P.C. has sponsored the creation of one or more 401k plans.

Company Name:PATHOLOGY MEDICAL SERVICES, P.C.
Employer identification number (EIN):470549869
NAIC Classification:621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-01-01RYAN DEHAAN RYAN DEHAAN2017-10-03
5012015-01-01RYAN DEHAAN RYAN DEHAAN2016-09-06
5012014-01-01DEBORAH K. DAVIDSON DEBORAH K. DAVIDSON2015-10-03
5012013-01-01DEBORAH K. DAVIDSON DEBORAH K. DAVIDSON2014-10-06
5012012-01-01DEBORAH K. DAVIDSON DEBORAH K. DAVIDSON2013-10-09
5012011-01-01DEBORAH K. DAVIDSON DEBORAH K. DAVIDSON2012-10-11
5012010-01-01DEBORAH K. DAVIDSON DEBORAH K. DAVIDSON2011-10-11
5012009-01-01DEBORAH K. DAVIDSON DEBORAH K. DAVIDSON2010-10-12

Plan Statistics for BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE

401k plan membership statisitcs for BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE

Measure Date Value
2016: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-01-01168
Total number of active participants reported on line 7a of the Form 55002016-01-0113
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0113
2015: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-01-01168
Total number of active participants reported on line 7a of the Form 55002015-01-01168
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01168
2014: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-01-01168
Total number of active participants reported on line 7a of the Form 55002014-01-01168
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01168
2013: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-01-01180
Total number of active participants reported on line 7a of the Form 55002013-01-01168
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01168
2012: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-01-01172
Total number of active participants reported on line 7a of the Form 55002012-01-01180
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01180
2011: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-01-01156
Total number of active participants reported on line 7a of the Form 55002011-01-01172
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01172
2010: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2010 401k membership
Total participants, beginning-of-year2010-01-01146
Total number of active participants reported on line 7a of the Form 55002010-01-01156
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01156
2009: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-01-01145
Total number of active participants reported on line 7a of the Form 55002009-01-01146
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01146

Form 5500 Responses for BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE

2016: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01This submission is the final filingYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: BASIC TERM LIFE & ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number038105G
Policy instance 1
Insurance contract or identification number038105G
Number of Individuals Covered168
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,090
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $50,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,090
Insurance broker organization code?3
Insurance broker nameFIRST INS GROUP LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number038105G
Policy instance 1
Insurance contract or identification number038105G
Number of Individuals Covered168
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,116
Total amount of fees paid to insurance companyUSD $665
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $51,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,116
Insurance broker organization code?3
Amount paid for insurance broker fees665
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION (BONUS) PAID TO BROKER BY HARTFORD
Insurance broker nameFIRST INS GROUP LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number038105G
Policy instance 1
Insurance contract or identification number038105G
Number of Individuals Covered168
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,316
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $53,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,316
Insurance broker organization code?3
Insurance broker nameFIRST INS GROUP LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06160
Policy instance 1
Insurance contract or identification number06160
Number of Individuals Covered180
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,708
Total amount of fees paid to insurance companyUSD $63
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $54,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,674
Insurance broker organization code?3
Amount paid for insurance broker fees63
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker nameAXA ASSISTANCE USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06160
Policy instance 1
Insurance contract or identification number06160
Number of Individuals Covered172
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,496
Total amount of fees paid to insurance companyUSD $57
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $47,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05567676
Policy instance 1
Insurance contract or identification numberKM05567676
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $287
Total amount of fees paid to insurance companyUSD $38
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $253
Additional information about fees paid to insurance brokerLIFE BASE COMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees34
Insurance broker nameBENEFIT ADMIN INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06160
Policy instance 2
Insurance contract or identification number06160
Number of Individuals Covered156
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,769
Total amount of fees paid to insurance companyUSD $50
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $43,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,769
Additional information about fees paid to insurance brokerSALES AND SERVICE COMPENSATION
Insurance broker organization code?3
Amount paid for insurance broker fees50
Insurance broker nameAXA ASSISTANCE USA

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