401k Plan data: ORPINE, INC. LIFE BENEFIT PLAN plan

ORPINE, INC. LIFE BENEFIT PLAN 401k Plan overview

Plan Name	ORPINE, INC. LIFE BENEFIT PLAN
Plan identification number	504

ORPINE, INC. LIFE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: ORPINE, INC.

Employer identification number (EIN): 204526283

NAIC Classification: 443142
NAIC Description: Electronics Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ORPINE, INC. LIFE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2017-02-01
504 2016-02-01 SNIGDHA KATPALLY

Plan Statistics for ORPINE, INC. LIFE BENEFIT PLAN

401k plan membership statisitcs for ORPINE, INC. LIFE BENEFIT PLAN

Measure Date Value
2017: ORPINE, INC. LIFE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-02-01 221
Total number of active participants reported on line 7a of the Form 5500 2017-02-01 0
Total of all active and inactive participants 2017-02-01 0
2016: ORPINE, INC. LIFE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-02-01 221
Total number of active participants reported on line 7a of the Form 5500 2016-02-01 221
Total of all active and inactive participants 2016-02-01 221

Measure	Date	Value
2017: ORPINE, INC. LIFE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-02-01	221
Total number of active participants reported on line 7a of the Form 5500	2017-02-01	0
Total of all active and inactive participants	2017-02-01	0
2016: ORPINE, INC. LIFE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-02-01	221
Total number of active participants reported on line 7a of the Form 5500	2016-02-01	221
Total of all active and inactive participants	2016-02-01	221

Form 5500 Responses for ORPINE, INC. LIFE BENEFIT PLAN

2017: ORPINE, INC. LIFE BENEFIT PLAN 2017 form 5500 responses
2017-02-01	Type of plan entity	Single employer plan
2017-02-01	Submission has been amended	No
2017-02-01	This submission is the final filing	Yes
2017-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-02-01	Plan is a collectively bargained plan	No
2017-02-01	Plan funding arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement – Insurance	Yes
2016: ORPINE, INC. LIFE BENEFIT PLAN 2016 form 5500 responses
2016-02-01	Type of plan entity	Single employer plan
2016-02-01	First time form 5500 has been submitted	Yes
2016-02-01	Submission has been amended	No
2016-02-01	This submission is the final filing	No
2016-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-02-01	Plan is a collectively bargained plan	No
2016-02-01	Plan funding arrangement – Insurance	Yes
2016-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )

Policy contract number

GA8160

Policy instance

Insurance contract or identification number	GA8160
Number of Individuals Covered	158
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
Total amount of commissions paid to insurance broker	USD $37,827
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
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 $816,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,827
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	CORE BENEFIT SOLUTIONS LLC

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Company Name:	ORPINE, INC.
Employer identification number (EIN):	204526283
NAIC Classification:	443142
NAIC Description:	Electronics Stores