401k Plan data: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN plan

GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 401k Plan overview

Plan Name	GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN
Plan identification number	503

GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision Other welfare benefit cover

401k Sponsoring company profile

GOODWILL OF WESTERN MISSOURI & EASTERN KANSAS has sponsored the creation of one or more 401k plans.

Company Name: GOODWILL OF WESTERN MISSOURI & EASTERN KANSAS

Employer identification number (EIN): 431125281

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-01-01 KEVIN BENTLEY
503 2016-01-01 STEFANY WILLIAMS
503 2015-01-01 KEVIN BENTLEY
503 2014-01-01 KEVIN BENTLEY
503 2013-01-01 KEVIN BENTLEY

Plan id#	Filing Submission Date	Name of Administrator
503	2017-01-01	KEVIN BENTLEY
503	2016-01-01	STEFANY WILLIAMS
503	2015-01-01	KEVIN BENTLEY
503	2014-01-01	KEVIN BENTLEY
503	2013-01-01	KEVIN BENTLEY

Plan Statistics for GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN

401k plan membership statisitcs for GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN

Measure Date Value
2017: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
2016: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 113
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 113
2015: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 141
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 144
2014: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 128
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 130
2013: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 107
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 109

Measure	Date	Value
2017: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
2016: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	113
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	113
2015: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	141
Number of retired or separated participants receiving benefits	2015-01-01	3
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	144
2014: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	128
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	130
2013: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	107
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	109

Form 5500 Responses for GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN

2017: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION 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	Yes
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: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION 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: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION 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: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION 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
2013: GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS VISION PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5469055

Policy instance

Insurance contract or identification number	5469055
Number of Individuals Covered	111
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,075
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	Yes
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	ACCIDENT AND CRITICAL ILLNESS
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 $27,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,075
Insurance broker organization code?	3
Insurance broker name	TRUSS, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5469055

Policy instance

Insurance contract or identification number	5469055
Number of Individuals Covered	141
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,593
Total amount of fees paid to insurance company	USD $12
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	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $20,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,476
Insurance broker organization code?	3
Amount paid for insurance broker fees	12
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS
Insurance broker name	TRUSS, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5469055

Policy instance

Insurance contract or identification number	5469055
Number of Individuals Covered	128
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,435
Total amount of fees paid to insurance company	USD $688
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	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $17,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,435
Amount paid for insurance broker fees	688
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	POWER GROUP COMPANY LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0754041

Policy instance

Insurance contract or identification number	0754041
Number of Individuals Covered	107
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,342
Total amount of fees paid to insurance company	USD $0
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	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $14,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,342
Insurance broker organization code?	3
Insurance broker name	POWER GROUP COMPANY LLC

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Company Name:	GOODWILL OF WESTERN MISSOURI & EASTERN KANSAS
Employer identification number (EIN):	431125281
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations