401k Plan data: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN plan

VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 401k Plan overview

Plan Name	VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN
Plan identification number	541

VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

WELLS LAMONT CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: WELLS LAMONT CORPORATION

Employer identification number (EIN): 364264748

NAIC Classification: 315990
NAIC Description: Apparel Accessories and Other Apparel Manufacturing

Additional information about WELLS LAMONT CORPORATION

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0285346

More information about WELLS LAMONT CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
541 2017-01-01 THERESA CHIP
541 2016-01-01 THERESA CHIP THERESA CHIP 2017-07-07
541 2016-01-01 THERESA CHIP 2017-07-07
541 2015-01-01 THERESA CHIP 2016-07-13
541 2014-01-01 THERESA CHIP THERESA CHIP 2015-07-15
541 2012-01-01 THERESA CHIP THERESA CHIP 2013-07-25
541 2011-01-01 THERESA CHIP THERESA CHIP 2012-07-24
541 2009-01-01 THERESA CHIP THERESA CHIP 2010-08-02

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
541	2017-01-01	THERESA CHIP
541	2016-01-01	THERESA CHIP	THERESA CHIP	2017-07-07
541	2016-01-01		THERESA CHIP	2017-07-07
541	2015-01-01		THERESA CHIP	2016-07-13
541	2014-01-01	THERESA CHIP	THERESA CHIP	2015-07-15
541	2012-01-01	THERESA CHIP	THERESA CHIP	2013-07-25
541	2011-01-01	THERESA CHIP	THERESA CHIP	2012-07-24
541	2009-01-01	THERESA CHIP	THERESA CHIP	2010-08-02

Plan Statistics for VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

401k plan membership statisitcs for VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

Measure Date Value
2017: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 40
Total of all active and inactive participants 2017-01-01 40
2016: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 37
Total of all active and inactive participants 2016-01-01 37
2015: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 34
Total of all active and inactive participants 2015-01-01 34
2014: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 36
Total of all active and inactive participants 2014-01-01 36
2012: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 33
Total of all active and inactive participants 2012-01-01 33
2011: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 35
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 38
Total of all active and inactive participants 2011-01-01 38
2009: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 43
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 33
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 33

Measure	Date	Value
2017: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	40
Total of all active and inactive participants	2017-01-01	40
2016: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	37
Total of all active and inactive participants	2016-01-01	37
2015: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	34
Total of all active and inactive participants	2015-01-01	34
2014: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	36
Total of all active and inactive participants	2014-01-01	36
2012: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	33
Total of all active and inactive participants	2012-01-01	33
2011: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	35
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	38
Total of all active and inactive participants	2011-01-01	38
2009: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	43
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	33
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	33

Financial Data on VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

Measure	Date	Value
2016 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$4,280
Expenses. Total of all expenses incurred	2016-12-31	$0
Value of fidelity bond covering the plan	2016-12-31	$2,000,000
Total contributions received or receivable from participants	2016-12-31	$4,280
Net income (gross income less expenses)	2016-12-31	$4,280
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$0
2015 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$4,220
Expenses. Total of all expenses incurred	2015-12-31	$0
Value of fidelity bond covering the plan	2015-12-31	$2,000,000
Total contributions received or receivable from participants	2015-12-31	$4,220
Net income (gross income less expenses)	2015-12-31	$4,220
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$0
2014 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$4,076
Expenses. Total of all expenses incurred	2014-12-31	$0
Value of fidelity bond covering the plan	2014-12-31	$2,000,000
Total contributions received or receivable from participants	2014-12-31	$4,076
Net income (gross income less expenses)	2014-12-31	$4,076
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$0
2013 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$4,076
Expenses. Total of all expenses incurred	2013-12-31	$0
Total plan assets at beginning of year	2013-12-31	$0
Value of fidelity bond covering the plan	2013-12-31	$2,000,000
Total contributions received or receivable from participants	2013-12-31	$4,076
Net income (gross income less expenses)	2013-12-31	$4,076
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$0
2012 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$4,018
Expenses. Total of all expenses incurred	2012-12-31	$0
Total plan assets at beginning of year	2012-12-31	$0
Value of fidelity bond covering the plan	2012-12-31	$2,000,000
Total contributions received or receivable from participants	2012-12-31	$4,018
Net income (gross income less expenses)	2012-12-31	$4,018
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$0
2011 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$4,481
Expenses. Total of all expenses incurred	2011-12-31	$0
Total plan assets at beginning of year	2011-12-31	$0
Value of fidelity bond covering the plan	2011-12-31	$2,000,000
Total contributions received or receivable from participants	2011-12-31	$4,481
Net income (gross income less expenses)	2011-12-31	$4,481
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$0
2010 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$4,141
Expenses. Total of all expenses incurred	2010-12-31	$0
Value of fidelity bond covering the plan	2010-12-31	$2,000,000
Total contributions received or receivable from participants	2010-12-31	$4,141
Net income (gross income less expenses)	2010-12-31	$4,141
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0

Form 5500 Responses for VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

2017: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2012: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )

Policy contract number

83025909

Policy instance

Insurance contract or identification number	83025909
Number of Individuals Covered	40
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH
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 $4,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	WELLS LAMONT CORPORATION
Employer identification number (EIN):	364264748
NAIC Classification:	315990
NAIC Description:	Apparel Accessories and Other Apparel Manufacturing

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0285346