401k Plan data: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN plan

HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 401k Plan overview

Plan Name	HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN
Plan identification number	502

HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Temporary disability (accident and sickness) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

HN FUNKHOUSER & CO has sponsored the creation of one or more 401k plans.

Company Name: HN FUNKHOUSER & CO

Employer identification number (EIN): 540832073

NAIC Classification: 447100
NAIC Description: Gasoline Stations, Gas

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2013-01-01 REBECCA HERNLEY
502 2012-01-01 REBECCA HERNLEY
502 2010-01-01 REBECCA HERNLEY
502 2009-02-01 ROBERT CLAYTOR 2010-08-24
502 2009-02-01 ROBERT CLAYTOR 2010-08-25
502 2009-02-01 ROBERT CLAYTOR

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2013-01-01	REBECCA HERNLEY
502	2012-01-01	REBECCA HERNLEY
502	2010-01-01	REBECCA HERNLEY
502	2009-02-01		ROBERT CLAYTOR	2010-08-24
502	2009-02-01		ROBERT CLAYTOR	2010-08-25
502	2009-02-01	ROBERT CLAYTOR

Plan Statistics for HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN

401k plan membership statisitcs for HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN

Measure Date Value
2013: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 82
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 82
Total of all active and inactive participants 2013-01-01 82
2012: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 82
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 82
2010: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 146
Number of retired or separated participants receiving benefits 2010-01-01 1
Total of all active and inactive participants 2010-01-01 147
2009: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 142
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 117
Number of retired or separated participants receiving benefits 2009-02-01 0
Number of other retired or separated participants entitled to future benefits 2009-02-01 0
Total of all active and inactive participants 2009-02-01 117

Measure	Date	Value
2013: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	82
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	82
Total of all active and inactive participants	2013-01-01	82
2012: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	82
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	82
2010: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	146
Number of retired or separated participants receiving benefits	2010-01-01	1
Total of all active and inactive participants	2010-01-01	147
2009: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	142
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	117
Number of retired or separated participants receiving benefits	2009-02-01	0
Number of other retired or separated participants entitled to future benefits	2009-02-01	0
Total of all active and inactive participants	2009-02-01	117

Form 5500 Responses for HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN

2013: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	Submission has been amended	Yes
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
2012: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Multi-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
2010: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Multi-employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: HN FUNKHOUSER & CO. DENTAL INSURANCE PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Multi-employer plan
2009-02-01	Submission has been amended	No
2009-02-01	This submission is the final filing	No
2009-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-02-01	Plan is a collectively bargained plan	No
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FG1D1598

Policy instance

Insurance contract or identification number	FG1D1598
Number of Individuals Covered	82
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,174
Total amount of fees paid to insurance company	USD $374
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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 $43,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,174
Amount paid for insurance broker fees	374
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	FAISON GROUP BENEFITS, INC.

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FG1D1598

Policy instance

Insurance contract or identification number	FG1D1598
Number of Individuals Covered	82
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,211
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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 $44,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,211
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FAISON GROUP BENEFITS, INC.

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00455388

Policy instance

Insurance contract or identification number	00455388
Number of Individuals Covered	150
Insurance policy start date	2010-02-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,566
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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 $51,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

HN FUNKHOUSER & CO. HEALTH INSURANCE PLAN [EIN = 540832075]

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Company Name:	HN FUNKHOUSER & CO
Employer identification number (EIN):	540832073
NAIC Classification:	447100
NAIC Description:	Gasoline Stations, Gas