401k Plan data: HIMATSINGKA AMERICA, INC. plan

HIMATSINGKA AMERICA, INC. 401k Plan overview

Plan Name	HIMATSINGKA AMERICA, INC.
Plan identification number	501

HIMATSINGKA AMERICA, INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: HIMATSINGKA AMERICA, INC.

Employer identification number (EIN): 201026406

NAIC Classification: 424990
NAIC Description: Other Miscellaneous Nondurable Goods Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HIMATSINGKA AMERICA, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 TRICIA BURGESS
501 2014-01-01 TRICIA BURGESS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	TRICIA BURGESS
501	2014-01-01	TRICIA BURGESS

Plan Statistics for HIMATSINGKA AMERICA, INC.

401k plan membership statisitcs for HIMATSINGKA AMERICA, INC.

Measure Date Value
2015: HIMATSINGKA AMERICA, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 114
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 2015-01-01 114
Total participants 2015-01-01 114
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: HIMATSINGKA AMERICA, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 114
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 114
Total participants 2014-01-01 114

Measure	Date	Value
2015: HIMATSINGKA AMERICA, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	114
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	114
Total participants	2015-01-01	114
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: HIMATSINGKA AMERICA, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	114
Number of retired or separated participants receiving benefits	2014-01-01	0
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	114
Total participants	2014-01-01	114

Form 5500 Responses for HIMATSINGKA AMERICA, INC.

2015: HIMATSINGKA AMERICA, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HIMATSINGKA AMERICA, INC. 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010174832

Policy instance

Insurance contract or identification number	000010174832
Number of Individuals Covered	114
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $2,118
Total amount of fees paid to insurance company	USD $2,313
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $22,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $771
Amount paid for insurance broker fees	2313
Additional information about fees paid to insurance broker	BROKER BONUS AND OVERRIDES
Insurance broker organization code?	3
Insurance broker name	HIRAM COHEN & SON INC

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

Policy contract number

00388461

Policy instance

Insurance contract or identification number	00388461
Number of Individuals Covered	113
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $774
Total amount of fees paid to insurance company	USD $388
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $7,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $774
Amount paid for insurance broker fees	388
Additional information about fees paid to insurance broker	-
Insurance broker organization code?	3
Insurance broker name	HIRAM COHEN & SON INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010174833

Policy instance

Insurance contract or identification number	000010174833
Number of Individuals Covered	114
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $3,959
Total amount of fees paid to insurance company	USD $2,715
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,877
Amount paid for insurance broker fees	2715
Additional information about fees paid to insurance broker	BROKER BONUS AND OVERRIDES
Insurance broker organization code?	3
Insurance broker name	HIRAM COHEN & SON INC

THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 )

Policy contract number

GVNY18407

Policy instance

Insurance contract or identification number	GVNY18407
Number of Individuals Covered	114
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,002
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,002
Insurance broker organization code?	3
Insurance broker name	EMERSON REID & COMPANY, INC.

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010174832

Policy instance

Insurance contract or identification number	000010174832
Number of Individuals Covered	114
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $2,156
Total amount of fees paid to insurance company	USD $1,164
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $23,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1164
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,156
Insurance broker name	HIRAM COHEN & SON INC

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

Policy contract number

00388461

Policy instance

Insurance contract or identification number	00388461
Number of Individuals Covered	114
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $889
Total amount of fees paid to insurance company	USD $302
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $83
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	302
Insurance broker name	HIRAM COHEN & SON INC

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Company Name:	HIMATSINGKA AMERICA, INC.
Employer identification number (EIN):	201026406
NAIC Classification:	424990
NAIC Description:	Other Miscellaneous Nondurable Goods Merchant Wholesalers