401k Plan data: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN plan

POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN
Plan identification number	501

POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover 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.

401k Sponsoring company profile

POLYTRONIX, INC. has sponsored the creation of one or more 401k plans.

Company Name: POLYTRONIX, INC.

Employer identification number (EIN): 200440938

NAIC Classification: 335900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-10-01
501 2019-10-01
501 2016-10-01 LORI WILLIAMS LORI WILLIAMS 2017-12-19
501 2015-10-01 LORI WILLIAMS LORI WILLIAMS 2017-12-19
501 2014-10-01 LORI WILLIAMS LORI WILLIAMS 2017-12-19
501 2014-07-01 LORI WILLIAMS LORI WILLIAMS 2017-12-19
501 2013-07-01 LORI WILLIAMS LORI WILLIAMS 2017-12-19

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2020-10-01
501	2019-10-01
501	2016-10-01	LORI WILLIAMS	LORI WILLIAMS	2017-12-19
501	2015-10-01	LORI WILLIAMS	LORI WILLIAMS	2017-12-19
501	2014-10-01	LORI WILLIAMS	LORI WILLIAMS	2017-12-19
501	2014-07-01	LORI WILLIAMS	LORI WILLIAMS	2017-12-19
501	2013-07-01	LORI WILLIAMS	LORI WILLIAMS	2017-12-19

Plan Statistics for POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN

401k plan membership statisitcs for POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN

Measure Date Value
2020: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 104
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 86
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 86
2019: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 106
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 106
2016: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 104
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 109
Total of all active and inactive participants 2016-10-01 109
2015: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 117
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 104
Total of all active and inactive participants 2015-10-01 104
2014: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 105
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 118
Total of all active and inactive participants 2014-10-01 118
Total participants, beginning-of-year 2014-07-01 122
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 121
Total of all active and inactive participants 2014-07-01 121
2013: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 102
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 119
Total of all active and inactive participants 2013-07-01 119

Measure	Date	Value
2020: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	104
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	86
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	86
2019: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	106
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	106
2016: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	104
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	109
Total of all active and inactive participants	2016-10-01	109
2015: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	117
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	104
Total of all active and inactive participants	2015-10-01	104
2014: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	105
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	118
Total of all active and inactive participants	2014-10-01	118
Total participants, beginning-of-year	2014-07-01	122
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	121
Total of all active and inactive participants	2014-07-01	121
2013: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	102
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	119
Total of all active and inactive participants	2013-07-01	119

Form 5500 Responses for POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN

2020: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2019: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2016: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: POLYTRONIX, INC. HEALTH & WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	First time form 5500 has been submitted	Yes
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number	248188
Policy instance	1
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number	921855-000,099
Policy instance	2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	877977
Policy instance	3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number	248188
Policy instance	1
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number	921855-000,099
Policy instance	2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	877977
Policy instance	3

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Company Name:	POLYTRONIX, INC.
Employer identification number (EIN):	200440938
NAIC Classification:	335900