401k Plan data: CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY plan

CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY 401k Plan overview

Plan Name	CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY
Plan identification number	501

CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

CUSTOM AIR CONDITIONING AND HEATING CO has sponsored the creation of one or more 401k plans.

Company Name: CUSTOM AIR CONDITIONING AND HEATING CO

Employer identification number (EIN): 310889627

NAIC Classification: 238220
NAIC Description: Plumbing, Heating, and Air-Conditioning Contractors

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-07-01
501 2015-07-01 BEVERLY MCCAIN

Plan Statistics for CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY

401k plan membership statisitcs for CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY

Measure Date Value
2016: CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY 2016 401k membership
Total participants, beginning-of-year 2016-07-01 110
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 112
Total of all active and inactive participants 2016-07-01 112
Total participants 2016-07-01 112
2015: CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY 2015 401k membership
Total participants, beginning-of-year 2015-07-01 0
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 110
Total of all active and inactive participants 2015-07-01 110
Total participants 2015-07-01 110

Measure	Date	Value
2016: CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY 2016 401k membership
Total participants, beginning-of-year	2016-07-01	110
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	112
Total of all active and inactive participants	2016-07-01	112
Total participants	2016-07-01	112
2015: CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY 2015 401k membership
Total participants, beginning-of-year	2015-07-01	0
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	110
Total of all active and inactive participants	2015-07-01	110
Total participants	2015-07-01	110

Form 5500 Responses for CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY

2016: CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: CUSTOM AIR CONDITIONING & HEATING CO LIFE AND DISABILITY 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	First time form 5500 has been submitted	Yes
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

00172300

Policy instance

Insurance contract or identification number	00172300
Number of Individuals Covered	110
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $22,508
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $58,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,513
Insurance broker organization code?	3
Insurance broker name	BENE KELLY INS AGENCY INC

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Company Name:	CUSTOM AIR CONDITIONING AND HEATING CO
Employer identification number (EIN):	310889627
NAIC Classification:	238220
NAIC Description:	Plumbing, Heating, and Air-Conditioning Contractors