401k Plan data: VISION BENEFITS PLAN FOR PEAK RELIABILITY plan

VISION BENEFITS PLAN FOR PEAK RELIABILITY 401k Plan overview

Plan Name	VISION BENEFITS PLAN FOR PEAK RELIABILITY
Plan identification number	503

VISION BENEFITS PLAN FOR PEAK RELIABILITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

PEAK RELIABILITY has sponsored the creation of one or more 401k plans.

Company Name: PEAK RELIABILITY

Employer identification number (EIN): 463889916

NAIC Classification: 519100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VISION BENEFITS PLAN FOR PEAK RELIABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-01-01 REGANA DAVIS REGANA DAVIS 2016-11-22
503 2014-01-01 GARY STEPHENSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2015-01-01	REGANA DAVIS		REGANA DAVIS	2016-11-22
503	2014-01-01	GARY STEPHENSON

Plan Statistics for VISION BENEFITS PLAN FOR PEAK RELIABILITY

401k plan membership statisitcs for VISION BENEFITS PLAN FOR PEAK RELIABILITY

Measure Date Value
2015: VISION BENEFITS PLAN FOR PEAK RELIABILITY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
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 0
Total participants 2015-01-01 0
2014: VISION BENEFITS PLAN FOR PEAK RELIABILITY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 119
Total of all active and inactive participants 2014-01-01 119
Total participants 2014-01-01 119

Measure	Date	Value
2015: VISION BENEFITS PLAN FOR PEAK RELIABILITY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
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	0
Total participants	2015-01-01	0
2014: VISION BENEFITS PLAN FOR PEAK RELIABILITY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	119
Total of all active and inactive participants	2014-01-01	119
Total participants	2014-01-01	119

Form 5500 Responses for VISION BENEFITS PLAN FOR PEAK RELIABILITY

2015: VISION BENEFITS PLAN FOR PEAK RELIABILITY 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	Yes
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 – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: VISION BENEFITS PLAN FOR PEAK RELIABILITY 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

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9891128

Policy instance

Insurance contract or identification number	9891128
Number of Individuals Covered	325
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $798
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 $24,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $475
Insurance broker name	JOHNSON RESOURCES

Potentially related plans

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Company Name:	PEAK RELIABILITY
Employer identification number (EIN):	463889916
NAIC Classification:	519100