401k Plan data: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN plan

PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 401k Plan overview

Plan Name	PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN
Plan identification number	506

PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Other welfare benefit cover

401k Sponsoring company profile

PHOTONIS has sponsored the creation of one or more 401k plans.

Company Name: PHOTONIS

Employer identification number (EIN): 232464652

NAIC Classification: 334410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2013-01-01 JEANNINE BOGACKI JEANNINE BOGACKI 2014-03-27
506 2012-01-01 JEFFREY BAKER
506 2011-01-01 JEFFREY BAKER
506 2009-01-01 JEFFREY BAKER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
506	2013-01-01	JEANNINE BOGACKI	JEANNINE BOGACKI	2014-03-27
506	2012-01-01	JEFFREY BAKER
506	2011-01-01	JEFFREY BAKER
506	2009-01-01	JEFFREY BAKER

Plan Statistics for PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN

401k plan membership statisitcs for PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN

Measure Date Value
2013: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 102
Total of all active and inactive participants 2013-01-01 102
Total participants 2013-01-01 102
2012: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 101
Total of all active and inactive participants 2012-01-01 101
Total participants 2012-01-01 101
2011: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 108
Total of all active and inactive participants 2011-01-01 108
Total participants 2011-01-01 108
2009: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 113
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 113
Number of participants with account balances 2009-01-01 0

Measure	Date	Value
2013: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	102
Total of all active and inactive participants	2013-01-01	102
Total participants	2013-01-01	102
2012: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	101
Total of all active and inactive participants	2012-01-01	101
Total participants	2012-01-01	101
2011: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	108
Total of all active and inactive participants	2011-01-01	108
Total participants	2011-01-01	108
2009: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	113
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	113
Number of participants with account balances	2009-01-01	0

Form 5500 Responses for PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN

2013: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
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: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single 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
2011: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: PHOTONIS USA PENNSYLVANIA, INC. TRAVEL AND ACCIDENT WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

64084492

Policy instance

Insurance contract or identification number	64084492
Insurance policy start date	2012-07-01
Insurance policy end date	2013-07-01
Total amount of commissions paid to insurance broker	USD $0
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker name	WILLIS OF NEW YORK, INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

64084492

Policy instance

Insurance contract or identification number	64084492
Insurance policy start date	2011-07-01
Insurance policy end date	2012-07-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker name	WILLIS OF NEW YORK, INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

64084492

Policy instance

Insurance contract or identification number	64084492
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $1,012
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

64084492

Policy instance

Insurance contract or identification number	64084492
Insurance policy start date	2009-07-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

PHOTONIS USA, INC. RETIREMENT AND SAVINGS PLAN [EIN = 232999112]

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Company Name:	PHOTONIS
Employer identification number (EIN):	232464652
NAIC Classification:	334410