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| Plan Name | MCCOY & MCCOY LABORATORIES, INC. GROUP BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MCCOY & MCCOY LABORATORIES, INC. |
| Employer identification number (EIN): | 610879053 |
| NAIC Classification: | 312110 |
| NAIC Description: | Soft Drink and Ice Manufacturing |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2015-05-01 | ||||
| 501 | 2014-05-01 |
| Measure | Date | Value |
|---|---|---|
| 2015: MCCOY & MCCOY LABORATORIES, INC. GROUP BENEFITS PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-05-01 | 60 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 0 |
| Number of retired or separated participants receiving benefits | 2015-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-05-01 | 0 |
| Total of all active and inactive participants | 2015-05-01 | 0 |
| 2014: MCCOY & MCCOY LABORATORIES, INC. GROUP BENEFITS PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-05-01 | 54 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 60 |
| Number of retired or separated participants receiving benefits | 2014-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-05-01 | 0 |
| Total of all active and inactive participants | 2014-05-01 | 60 |
| Measure | Date | Value |
|---|---|---|
| 2015 : MCCOY & MCCOY LABORATORIES, INC. GROUP BENEFITS PLAN 2015 401k financial data | ||
| Total income from all sources | 2015-12-31 | $279 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $279 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $279 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Net income (gross income less expenses) | 2015-12-31 | $0 |
| 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 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $279 |
| Total income from all sources | 2015-04-30 | $240,136 |
| Expenses. Total of all expenses incurred | 2015-04-30 | $240,136 |
| Benefits paid (including direct rollovers) | 2015-04-30 | $240,136 |
| Total plan assets at end of year | 2015-04-30 | $0 |
| Total plan assets at beginning of year | 2015-04-30 | $0 |
| Net income (gross income less expenses) | 2015-04-30 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2015-04-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-04-30 | $0 |
| Total contributions received or receivable from employer(s) | 2015-04-30 | $240,136 |
| 2015: MCCOY & MCCOY LABORATORIES, INC. GROUP BENEFITS PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Submission has been amended | No |
| 2015-05-01 | This submission is the final filing | Yes |
| 2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-05-01 | Plan is a collectively bargained plan | No |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: MCCOY & MCCOY LABORATORIES, INC. GROUP BENEFITS PLAN 2014 form 5500 responses | ||
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | First time form 5500 has been submitted | Yes |
| 2014-05-01 | Submission has been amended | No |
| 2014-05-01 | This submission is the final filing | No |
| 2014-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-05-01 | Plan is a collectively bargained plan | No |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| NATIONAL HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82538 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1883 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||
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| NATIONAL HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82538 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1883 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||
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