Fidelity bond in place
Not reported
Filing
Offshore Express Employee Benefit Plan
Offshore Express Inc. • EIN 72-0815708 • Plan year 2005
Filing Insights
Participants
Up371 → 399
28 • 7.55%
Assets
No comparison- → -
No earlier value available.
Investment Management Fee
-
Admin expenses - • Total expenses -
Filing Details
ContextNo event flags were generated for this filing.
Status Flags
Limited-scope audit performed
Not reported
Contributions transmitted on time
Not reported
Participant loans in default
Not reported
Leases in default
Not reported
Reportable party-in-interest issues
Not reported
Loss discovered during year
Not reported
Assets with undetermined value
Not reported
Non-cash contributions
Not reported
Assets held for investment
Not reported
5% transactions reported
Not reported
All plan assets distributed
Not reported
Benefits paid when due
Not reported
Plan blackout period
Not reported
Plan termination resolution adopted
Not reported
Counterparties
Company Timeline
This filing is highlighted inside the broader sponsor history.
| Year / Filing | Filings | Participants | Assets | Contributions | Contrib./Participant |
|---|---|---|---|---|---|
| 2016 | 2 | 110 | $4,722,252 | $177,315 | $1,612iApproximate average salary by contribution assumption: employee only about $40,299 at 4% or $26,866 at 6%; with 50% employer match about $26,866 at 4% or $17,911 at 6%; with 100% employer match about $20,149 at 4% or $13,433 at 6%. |
| Offshore Group 401K Savings Plan | - | 16 | $4,722,252 | $177,315 | $11,082iApproximate average salary by contribution assumption: employee only about $277,055 at 4% or $184,703 at 6%; with 50% employer match about $184,703 at 4% or $123,135 at 6%; with 100% employer match about $138,527 at 4% or $92,352 at 6%. |
| Offshore Express Employee Benefit Plan | - | 110 | - | - | - |
| 2015 | 2 | 138 | $8,219,146 | $935,440 | $6,779iApproximate average salary by contribution assumption: employee only about $169,464 at 4% or $112,976 at 6%; with 50% employer match about $112,976 at 4% or $75,317 at 6%; with 100% employer match about $84,732 at 4% or $56,488 at 6%. |
| Offshore Group 401K Savings Plan | - | 69 | $8,219,146 | $935,440 | $13,557iApproximate average salary by contribution assumption: employee only about $338,928 at 4% or $225,952 at 6%; with 50% employer match about $225,952 at 4% or $150,634 at 6%; with 100% employer match about $169,464 at 4% or $112,976 at 6%. |
| Offshore Express Employee Benefit Plan | - | 138 | - | - | - |
| 2014 | 2 | 151 | $7,868,307 | $842,774 | $5,581iApproximate average salary by contribution assumption: employee only about $139,532 at 4% or $93,021 at 6%; with 50% employer match about $93,021 at 4% or $62,014 at 6%; with 100% employer match about $69,766 at 4% or $46,511 at 6%. |
| Offshore Group 401K Savings Plan | - | 102 | $7,868,307 | $842,774 | $8,262iApproximate average salary by contribution assumption: employee only about $206,562 at 4% or $137,708 at 6%; with 50% employer match about $137,708 at 4% or $91,805 at 6%; with 100% employer match about $103,281 at 4% or $68,854 at 6%. |
| Offshore Express Employee Benefit Plan | - | 151 | - | - | - |
| 2013 | 2 | 131 | $7,487,957 | $876,247 | $6,689iApproximate average salary by contribution assumption: employee only about $167,223 at 4% or $111,482 at 6%; with 50% employer match about $111,482 at 4% or $74,321 at 6%; with 100% employer match about $83,611 at 4% or $55,741 at 6%. |
| Offshore Group 401K Savings Plan | - | 89 | $7,487,957 | $876,247 | $9,845iApproximate average salary by contribution assumption: employee only about $246,137 at 4% or $164,091 at 6%; with 50% employer match about $164,091 at 4% or $109,394 at 6%; with 100% employer match about $123,068 at 4% or $82,046 at 6%. |
| Offshore Express Employee Benefit Plan | - | 131 | - | - | - |
| 2012 | 2 | 152 | $7,032,862 | $1,039,740 | $6,840iApproximate average salary by contribution assumption: employee only about $171,010 at 4% or $114,007 at 6%; with 50% employer match about $114,007 at 4% or $76,004 at 6%; with 100% employer match about $85,505 at 4% or $57,003 at 6%. |
| Offshore Group 401K Savings Plan | - | 152 | $7,032,862 | $1,039,740 | $6,840iApproximate average salary by contribution assumption: employee only about $171,010 at 4% or $114,007 at 6%; with 50% employer match about $114,007 at 4% or $76,004 at 6%; with 100% employer match about $85,505 at 4% or $57,003 at 6%. |
| Offshore Express Employee Benefit Plan | - | 149 | - | - | - |
| 2011 | 2 | 181 | $6,174,134 | $1,035,759 | $5,722iApproximate average salary by contribution assumption: employee only about $143,061 at 4% or $95,374 at 6%; with 50% employer match about $95,374 at 4% or $63,583 at 6%; with 100% employer match about $71,530 at 4% or $47,687 at 6%. |
| Offshore Group 401K Savings Plan | - | 176 | $6,174,134 | $1,035,759 | $5,885iApproximate average salary by contribution assumption: employee only about $147,125 at 4% or $98,083 at 6%; with 50% employer match about $98,083 at 4% or $65,389 at 6%; with 100% employer match about $73,562 at 4% or $49,042 at 6%. |
| Offshore Express Employee Benefit Plan | - | 181 | - | - | - |
| 2010 | 2 | 148 | $6,271,638 | $1,105,083 | $7,467iApproximate average salary by contribution assumption: employee only about $186,669 at 4% or $124,446 at 6%; with 50% employer match about $124,446 at 4% or $82,964 at 6%; with 100% employer match about $93,335 at 4% or $62,223 at 6%. |
| Offshore Group 401K Savings Plan | - | 148 | $6,271,638 | $1,105,083 | $7,467iApproximate average salary by contribution assumption: employee only about $186,669 at 4% or $124,446 at 6%; with 50% employer match about $124,446 at 4% or $82,964 at 6%; with 100% employer match about $93,335 at 4% or $62,223 at 6%. |
| Offshore Express Employee Benefit Plan | - | 145 | - | - | - |
| 2009 | 2 | 240 | $7,294,845 | $1,589,818 | $6,624iApproximate average salary by contribution assumption: employee only about $165,606 at 4% or $110,404 at 6%; with 50% employer match about $110,404 at 4% or $73,603 at 6%; with 100% employer match about $82,803 at 4% or $55,202 at 6%. |
| Offshore Group 401K Savings Plan | - | 216 | $7,294,845 | $1,589,818 | $7,360iApproximate average salary by contribution assumption: employee only about $184,007 at 4% or $122,671 at 6%; with 50% employer match about $122,671 at 4% or $81,781 at 6%; with 100% employer match about $92,003 at 4% or $61,336 at 6%. |
| Offshore Express Employee Benefit Plan | - | 240 | - | - | - |
| 2008 | 2 | 294 | $7,230,632 | $1,952,280 | $6,640iApproximate average salary by contribution assumption: employee only about $166,010 at 4% or $110,673 at 6%; with 50% employer match about $110,673 at 4% or $73,782 at 6%; with 100% employer match about $83,005 at 4% or $55,337 at 6%. |
| Offshore Group 401K Savings Plan | - | 294 | $7,230,632 | $1,952,280 | $6,640iApproximate average salary by contribution assumption: employee only about $166,010 at 4% or $110,673 at 6%; with 50% employer match about $110,673 at 4% or $73,782 at 6%; with 100% employer match about $83,005 at 4% or $55,337 at 6%. |
| Offshore Express Employee Benefit Plan | - | 284 | - | - | - |
| 2007 | 2 | 427 | $8,870,268 | $2,748,693 | $6,437iApproximate average salary by contribution assumption: employee only about $160,931 at 4% or $107,287 at 6%; with 50% employer match about $107,287 at 4% or $71,525 at 6%; with 100% employer match about $80,465 at 4% or $53,644 at 6%. |
| Offshore Group 401K Savings Plan | - | 427 | $8,870,268 | $2,748,693 | $6,437iApproximate average salary by contribution assumption: employee only about $160,931 at 4% or $107,287 at 6%; with 50% employer match about $107,287 at 4% or $71,525 at 6%; with 100% employer match about $80,465 at 4% or $53,644 at 6%. |
| Offshore Express Employee Benefit Plan | - | 413 | - | - | - |
| 2006 | 2 | 483 | $7,279,198 | $2,226,980 | $4,611iApproximate average salary by contribution assumption: employee only about $115,268 at 4% or $76,845 at 6%; with 50% employer match about $76,845 at 4% or $51,230 at 6%; with 100% employer match about $57,634 at 4% or $38,423 at 6%. |
| Offshore Group 401K Savings Plan | - | 483 | $7,279,198 | $2,226,980 | $4,611iApproximate average salary by contribution assumption: employee only about $115,268 at 4% or $76,845 at 6%; with 50% employer match about $76,845 at 4% or $51,230 at 6%; with 100% employer match about $57,634 at 4% or $38,423 at 6%. |
| Offshore Express Employee Benefit Plan | - | 464 | - | - | - |
| 2005 | 2 | 399 | $5,205,734 | $1,968,006 | $4,932iApproximate average salary by contribution assumption: employee only about $123,309 at 4% or $82,206 at 6%; with 50% employer match about $82,206 at 4% or $54,804 at 6%; with 100% employer match about $61,654 at 4% or $41,103 at 6%. |
| Offshore Group 401K Savings Plan | - | 156 | $5,205,734 | $1,968,006 | $12,615iApproximate average salary by contribution assumption: employee only about $315,386 at 4% or $210,257 at 6%; with 50% employer match about $210,257 at 4% or $140,171 at 6%; with 100% employer match about $157,693 at 4% or $105,129 at 6%. |
| Offshore Express Employee Benefit Plan | Current | 399 | - | - | - |
| 2004 | 2 | 358 | $3,739,016 | $1,089,983 | $3,045iApproximate average salary by contribution assumption: employee only about $76,116 at 4% or $50,744 at 6%; with 50% employer match about $50,744 at 4% or $33,829 at 6%; with 100% employer match about $38,058 at 4% or $25,372 at 6%. |
| Offshore Group 401K Savings Plan | - | 326 | $3,739,016 | $1,089,983 | $3,344iApproximate average salary by contribution assumption: employee only about $83,588 at 4% or $55,725 at 6%; with 50% employer match about $55,725 at 4% or $37,150 at 6%; with 100% employer match about $41,794 at 4% or $27,863 at 6%. |
| Offshore Express Employee Benefit Plan | - | 358 | - | - | - |
| 2003 | 2 | 342 | $3,280,100 | $893,715 | $2,613iApproximate average salary by contribution assumption: employee only about $65,330 at 4% or $43,553 at 6%; with 50% employer match about $43,553 at 4% or $29,036 at 6%; with 100% employer match about $32,665 at 4% or $21,777 at 6%. |
| Offshore Group 401K Savings Plan | - | 284 | $3,280,100 | $893,715 | $3,147iApproximate average salary by contribution assumption: employee only about $78,672 at 4% or $52,448 at 6%; with 50% employer match about $52,448 at 4% or $34,965 at 6%; with 100% employer match about $39,336 at 4% or $26,224 at 6%. |
| Offshore Express Employee Benefit Plan | - | 342 | - | - | - |
| 2002 | 2 | 297 | $2,485,280 | $935,461 | $3,150iApproximate average salary by contribution assumption: employee only about $78,743 at 4% or $52,495 at 6%; with 50% employer match about $52,495 at 4% or $34,997 at 6%; with 100% employer match about $39,371 at 4% or $26,248 at 6%. |
| Offshore Group 401K Savings Plan | - | 243 | $2,485,280 | $935,461 | $3,850iApproximate average salary by contribution assumption: employee only about $96,241 at 4% or $64,161 at 6%; with 50% employer match about $64,161 at 4% or $42,774 at 6%; with 100% employer match about $48,120 at 4% or $32,080 at 6%. |
| Offshore Express Employee Benefit Plan | - | 297 | - | - | - |
| 2001 | 2 | 302 | $2,070,681 | $709,627 | $2,350iApproximate average salary by contribution assumption: employee only about $58,744 at 4% or $39,163 at 6%; with 50% employer match about $39,163 at 4% or $26,108 at 6%; with 100% employer match about $29,372 at 4% or $19,581 at 6%. |
| Offshore Group 401K Savings Plan | - | 302 | $2,070,681 | $709,627 | $2,350iApproximate average salary by contribution assumption: employee only about $58,744 at 4% or $39,163 at 6%; with 50% employer match about $39,163 at 4% or $26,108 at 6%; with 100% employer match about $29,372 at 4% or $19,581 at 6%. |
| Offshore Express Employee Benefit Plan | - | 241 | - | - | - |
| 2000 | 2 | 245 | $1,504,353 | $431,059 | $1,759iApproximate average salary by contribution assumption: employee only about $43,986 at 4% or $29,324 at 6%; with 50% employer match about $29,324 at 4% or $19,549 at 6%; with 100% employer match about $21,993 at 4% or $14,662 at 6%. |
| Offshore Group 401K Savings Plan | - | 176 | $1,504,353 | $431,059 | $2,449iApproximate average salary by contribution assumption: employee only about $61,230 at 4% or $40,820 at 6%; with 50% employer match about $40,820 at 4% or $27,213 at 6%; with 100% employer match about $30,615 at 4% or $20,410 at 6%. |
| Offshore Express Employee Benefit Plan | - | 245 | - | - | - |
| 1999 | 2 | 153 | $1,165,065 | $422,360 | $2,761iApproximate average salary by contribution assumption: employee only about $69,013 at 4% or $46,009 at 6%; with 50% employer match about $46,009 at 4% or $30,672 at 6%; with 100% employer match about $34,507 at 4% or $23,004 at 6%. |
| Offshore Group 401K Savings Plan | - | 153 | $1,165,065 | $422,360 | $2,761iApproximate average salary by contribution assumption: employee only about $69,013 at 4% or $46,009 at 6%; with 50% employer match about $46,009 at 4% or $30,672 at 6%; with 100% employer match about $34,507 at 4% or $23,004 at 6%. |
| Offshore Express Employee Benefit Plan | - | 145 | - | - | - |
Schedule Details
Schedule A
- Row 1
- Filing Id
- 84037346457296
- Form Id
- 75409913
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040004
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 2
- Filing Id
- 84037346457296
- Form Id
- 75409916
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040007
- Ins Broker 01 Name
- ANTHONY J. ALFORD
- Ins Broker 01 Street Addr
- P.O. BOX 910
- Ins Broker 01 City
- HOUMA
- Ins Broker 01 State
- LA
- Ins Broker 01 ZIP Code
- 70361
- Ins Broker Comm Pd 01 Amount
- $23,170
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 3
- Filing Id
- 84037346457296
- Form Id
- 75409915
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040006
- Ins Broker 01 Name
- ANTHONY ALFORD
- Ins Broker 01 Street Addr
- P O BOX 910
- Ins Broker 01 City
- HOUMA
- Ins Broker 01 State
- LA
- Ins Broker 01 ZIP Code
- 70361
- Ins Broker Comm Pd 01 Amount
- $1,560
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 4
- Filing Id
- 84037346457296
- Form Id
- 75409914
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040005
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 5
- Filing Id
- 84037346457296
- Form Id
- 75409911
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040002
- Ins Broker 01 Name
- KEN STAPLES
- Ins Broker 01 Street Addr
- P.O. BOX 910
- Ins Broker 01 City
- HOUMA
- Ins Broker 01 State
- LA
- Ins Broker 01 ZIP Code
- 70361
- Ins Broker Comm Pd 01 Amount
- $37,806
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 6
- Filing Id
- 84037346457296
- Form Id
- 75409912
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040003
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 7
- Filing Id
- 84037346457296
- Form Id
- 75409917
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040008
- Ins Broker 01 Name
- ANTHONY J. ALFORD INSURANCE CORP.
- Ins Broker 01 Street Addr
- P O BOX 910
- Ins Broker 01 City
- HOUMA
- Ins Broker 01 State
- LA
- Ins Broker 01 ZIP Code
- 70361
- Ins Broker Comm Pd 01 Amount
- $6,477
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 8
- Filing Id
- 84037346457296
- Form Id
- 75409915
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 5020376346457040006
- Ins Broker 01 Name
- ASSOCIATED BENEFIT PLANS, INC.
- Ins Broker 01 Street Addr
- 302 PINELAND DRIVE
- Ins Broker 01 City
- HOUMA
- Ins Broker 01 State
- LA
- Ins Broker 01 ZIP Code
- 70360
- Ins Broker Comm Pd 01 Amount
- $1,560
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 9
- Filing Id
- 84037346457296
- Form Id
- 75409911
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 5020376346457040002
- Ins Broker 01 Name
- ANTHONY J. ALFORD
- Ins Broker 01 Street Addr
- P.O. BOX 910
- Ins Broker 01 City
- HOUMA
- Ins Broker 01 State
- LA
- Ins Broker 01 ZIP Code
- 70361
- Ins Broker Comm Pd 01 Amount
- $37,770
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 10
- Filing Id
- 84037346457296
- Form Id
- 75409917
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 5020376346457040008
- Ins Broker 01 Name
- ASSOCIATED BENEFIT PLANS, INC.
- Ins Broker 01 Street Addr
- 114 OAKDALE LOOP
- Ins Broker 01 City
- HOUMA
- Ins Broker 01 State
- LA
- Ins Broker 01 ZIP Code
- 70360
- Ins Broker Comm Pd 01 Amount
- $6,477
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 11
- Filing Id
- 84037346457296
- Form Id
- 75409916
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 5020376346457040007
- Ins Broker 01 Name
- ASSOCIATED BENEFIT PLANS, INC.
- Ins Broker 01 Street Addr
- 302 PINELAND DRIVE
- Ins Broker 01 City
- HOUMA
- Ins Broker 01 State
- LA
- Ins Broker 01 ZIP Code
- 70360
- Ins Broker Comm Pd 01 Amount
- $23,170
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 12
- Ins Carrier Name: PHCS
- Filing Id
- 84037346457296
- Form Id
- 75409913
- Schedule A EIN
- 72-0815708
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2005-01-01
- Schedule A Tax Period
- 20051231
- Ins Carrier Name
- PHCS
- Ins Carrier EIN
- 04-3138814
- Ins Carrier Naic Code
- 00000
- Ins Contract Num
- S2498
- Ins Prsn Covered End of year Count
- 68
- Ins Policy From Date
- 2005-01-01
- Ins Policy To Date
- 2005-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- K
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $1,929
- Wlfr Acquis Cost Amount
- $0
- Row 13
- Ins Carrier Name: AMERICAN LIFECARE NETWORK
- Filing Id
- 84037346457296
- Form Id
- 75409912
- Schedule A EIN
- 72-0815708
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2005-01-01
- Schedule A Tax Period
- 20051231
- Ins Carrier Name
- AMERICAN LIFECARE NETWORK
- Ins Carrier EIN
- 72-0996998
- Ins Carrier Naic Code
- 00000
- Ins Contract Num
- S2498
- Ins Prsn Covered End of year Count
- 344
- Ins Policy From Date
- 2005-01-01
- Ins Policy To Date
- 2005-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- K
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $11,601
- Wlfr Acquis Cost Amount
- $0
- Row 14
- Ins Carrier Name: MEDCOM CARE MANAGEMENT
- Filing Id
- 84037346457296
- Form Id
- 75409914
- Schedule A EIN
- 72-0815708
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2005-01-01
- Schedule A Tax Period
- 20051231
- Ins Carrier Name
- MEDCOM CARE MANAGEMENT
- Ins Carrier EIN
- 72-1339762
- Ins Carrier Naic Code
- 00000
- Ins Contract Num
- S2498
- Ins Prsn Covered End of year Count
- 412
- Ins Policy From Date
- 2005-01-01
- Ins Policy To Date
- 2005-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- M
- Wlfr Type Bnft Oth Text
- UTILIZATION REVIEW
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $13,482
- Wlfr Acquis Cost Amount
- $0
- Row 15
- Ins Carrier Name: JEFFERSON PILOT FINANCIAL INSURANCE COMPANY
- Filing Id
- 84037346457296
- Form Id
- 75409915
- Schedule A EIN
- 72-0815708
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2005-01-01
- Schedule A Tax Period
- 20051231
- Ins Carrier Name
- JEFFERSON PILOT FINANCIAL INSURANCE COMPANY
- Ins Carrier EIN
- 62-0395665
- Ins Carrier Naic Code
- 70254
- Ins Contract Num
- 860050502
- Ins Prsn Covered End of year Count
- 258
- Ins Policy From Date
- 2005-01-01
- Ins Policy To Date
- 2005-04-30
- Ins Broker Comm Total Amount
- $3,120
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- DM
- Wlfr Type Bnft Oth Text
- AD&D
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $10,401
- Wlfr Acquis Cost Amount
- $0
- Row 16
- Ins Carrier Name: COMPANION LIFE
- Filing Id
- 84037346457296
- Form Id
- 75409917
- Schedule A EIN
- 72-0815708
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2005-01-01
- Schedule A Tax Period
- 20051231
- Ins Carrier Name
- COMPANION LIFE
- Ins Carrier EIN
- 57-0523959
- Ins Carrier Naic Code
- 77828
- Ins Contract Num
- 6112544867
- Ins Prsn Covered End of year Count
- 374
- Ins Policy From Date
- 2005-05-01
- Ins Policy To Date
- 2005-12-31
- Ins Broker Comm Total Amount
- $12,954
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- DM
- Wlfr Type Bnft Oth Text
- AD&D, VOL LIFE
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $62,142
- Wlfr Acquis Cost Amount
- $0
- Row 17
- Ins Carrier Name: AMERICAN UNITED LIFE
- Filing Id
- 84037346457296
- Form Id
- 75409911
- Schedule A EIN
- 72-0815708
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2005-01-01
- Schedule A Tax Period
- 20051231
- Ins Carrier Name
- AMERICAN UNITED LIFE
- Ins Carrier EIN
- 35-0145825
- Ins Carrier Naic Code
- 60895
- Ins Contract Num
- S2498
- Ins Prsn Covered End of year Count
- 1,021
- Ins Policy From Date
- 2005-01-01
- Ins Policy To Date
- 2005-12-31
- Ins Broker Comm Total Amount
- $75,576
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- ABH
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $354,091
- Wlfr Acquis Cost Amount
- $0
- Row 18
- Ins Carrier Name: PRUDENTIAL FINANCIAL
- Filing Id
- 84037346457296
- Form Id
- 75409916
- Schedule A EIN
- 72-0815708
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2005-01-01
- Schedule A Tax Period
- 20051231
- Ins Carrier Name
- PRUDENTIAL FINANCIAL
- Ins Carrier EIN
- 22-1211670
- Ins Carrier Naic Code
- 68241
- Ins Contract Num
- 09207
- Ins Prsn Covered End of year Count
- 478
- Ins Policy From Date
- 2005-01-01
- Ins Policy To Date
- 2005-12-31
- Ins Broker Comm Total Amount
- $46,340
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- DEF
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $154,464
- Wlfr Acquis Cost Amount
- $0
Schedule C
Schedule C Provider
Provider 1
Provider details
Source fields
- Row 1
- Filing Id
- 84037346457296
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040009
- Provider 01 Name
- GILSBAR, INC.
- Provider 01 EIN
- 72-0519951
- Provider 01 Position
- CONTRACT ADMINISTRATOR
- Provider 01 Relation
- NONE
- Provider 01 Salary Amount
- $0
- Provider 01 Fees Amount
- $71,116
- Provider 01 Srvc Code
- 12
- Row 2
- Filing Id
- 84037346457296
- Page Id
- 3
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 5020376346457040009
Schedule C Provider
Provider 2
Provider details
Source fields
- Row 3
- Filing Id
- 84037346457296
- Schedule C EIN
- 72-0815708
- Schedule C Plan number
- 501
- Schedule C Plan Year Begin Date
- 2005-01-01
- Schedule C Tax Period
- 20051231
- Provider Total Comp Paid Amount
- $0