401k Plan data: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN plan

PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 401k Plan overview

Plan Name	PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN
Plan identification number	501

PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

PELICAN STATE CREDIT UNION has sponsored the creation of one or more 401k plans.

Company Name: PELICAN STATE CREDIT UNION

Employer identification number (EIN): 720498240

NAIC Classification: 522130
NAIC Description: Credit Unions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 MICHELLE FORD
501 2013-01-01 MICHELLE FORD
501 2012-01-01 MICHELLE FORD
501 2011-01-01 MICHELLE FORD
501 2010-01-01 MICHELLE FORD
501 2009-01-01 MICHELLE FORD

Plan id#	Filing Submission Date	Name of Administrator
501	2015-01-01	MICHELLE FORD
501	2013-01-01	MICHELLE FORD
501	2012-01-01	MICHELLE FORD
501	2011-01-01	MICHELLE FORD
501	2010-01-01	MICHELLE FORD
501	2009-01-01	MICHELLE FORD

Plan Statistics for PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN

401k plan membership statisitcs for PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN

Measure Date Value
2015: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 170
Total of all active and inactive participants 2015-01-01 170
Total participants 2015-01-01 0
2013: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 147
Total of all active and inactive participants 2013-01-01 147
Total participants 2013-01-01 0
2012: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 142
Number of retired or separated participants receiving benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 144
Total participants 2012-01-01 0
2011: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 138
Total of all active and inactive participants 2011-01-01 138
Total participants 2011-01-01 138
2010: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 167
Number of retired or separated participants receiving benefits 2010-01-01 4
Total of all active and inactive participants 2010-01-01 171
Total participants 2010-01-01 171
2009: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 134
Number of retired or separated participants receiving benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 137
Total participants 2009-01-01 137

Measure	Date	Value
2015: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	170
Total of all active and inactive participants	2015-01-01	170
Total participants	2015-01-01	0
2013: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	147
Total of all active and inactive participants	2013-01-01	147
Total participants	2013-01-01	0
2012: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	142
Number of retired or separated participants receiving benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	144
Total participants	2012-01-01	0
2011: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	138
Total of all active and inactive participants	2011-01-01	138
Total participants	2011-01-01	138
2010: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	167
Number of retired or separated participants receiving benefits	2010-01-01	4
Total of all active and inactive participants	2010-01-01	171
Total participants	2010-01-01	171
2009: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	134
Number of retired or separated participants receiving benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	137
Total participants	2009-01-01	137

Form 5500 Responses for PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN

2015: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2013: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: PELICAN STATE CREDIT UNION GROUP BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN3P

Policy instance

Insurance contract or identification number	G000AN3P
Number of Individuals Covered	178
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,734
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,734
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

PSCU302

Policy instance

Insurance contract or identification number	PSCU302
Number of Individuals Covered	167
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,308
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,308
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

220557

Policy instance

Insurance contract or identification number	220557
Number of Individuals Covered	170
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,352
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $143,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,352
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

78036FF2

Policy instance

Insurance contract or identification number	78036FF2
Number of Individuals Covered	169
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $86,640
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $86,640
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

78036FF2

Policy instance

Insurance contract or identification number	78036FF2
Number of Individuals Covered	313
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $35,635
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,635
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AN3P

Policy instance

Insurance contract or identification number	G000AN3P
Number of Individuals Covered	140
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,233
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,233
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

220557

Policy instance

Insurance contract or identification number	220557
Number of Individuals Covered	153
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,691
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,691
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

PSCU302

Policy instance

Insurance contract or identification number	PSCU302
Number of Individuals Covered	142
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,283
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,283
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

PSCU302

Policy instance

Insurance contract or identification number	PSCU302
Number of Individuals Covered	141
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,116
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,116
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

78036FF2

Policy instance

Insurance contract or identification number	78036FF2
Number of Individuals Covered	293
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $55,226
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,226
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

146923

Policy instance

Insurance contract or identification number	146923
Number of Individuals Covered	148
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,865
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,865
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

220557

Policy instance

Insurance contract or identification number	220557
Number of Individuals Covered	139
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,088
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,088
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

PSCU302

Policy instance

Insurance contract or identification number	PSCU302
Number of Individuals Covered	271
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,109
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

146923

Policy instance

Insurance contract or identification number	146923
Number of Individuals Covered	143
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,165
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

78036FF2

Policy instance

Insurance contract or identification number	78036FF2
Number of Individuals Covered	275
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $56,082
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

PSCU302

Policy instance

Insurance contract or identification number	PSCU302
Number of Individuals Covered	136
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,122
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,122
Insurance broker name	HEALTH PLUS CONSULTING SERVICE

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

146923

Policy instance

Insurance contract or identification number	146923
Number of Individuals Covered	140
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,009
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,009
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE LOCATORS INC

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

78036FF2

Policy instance

Insurance contract or identification number	78036FF2
Number of Individuals Covered	268
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $42,072
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,072
Insurance broker organization code?	3
Insurance broker name	HEALTH PLUS INSURANCE OF LOUISIANA

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Company Name:	PELICAN STATE CREDIT UNION
Employer identification number (EIN):	720498240
NAIC Classification:	522130
NAIC Description:	Credit Unions