401k Plan data: WDFG HEALTH AND WELFARE PLAN plan

WDFG HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	WDFG HEALTH AND WELFARE PLAN
Plan identification number	501

WDFG HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) 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

WDFG NORTH AMERICA, LLC has sponsored the creation of one or more 401k plans.

Company Name: WDFG NORTH AMERICA, LLC

Employer identification number (EIN): 260840731

NAIC Classification: 453220
NAIC Description: Gift, Novelty, and Souvenir Stores

Additional information about WDFG NORTH AMERICA, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date: 2013-07-09

Company Identification Number: 4427934

Legal Registered Office Address: 80 State Street

Albany
United States of America (USA)
12207

More information about WDFG NORTH AMERICA, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WDFG HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-09-01 SANDRA KROEBER
501 2013-09-01 SANDRA KROEBER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2014-09-01	SANDRA KROEBER
501	2013-09-01	SANDRA KROEBER

Plan Statistics for WDFG HEALTH AND WELFARE PLAN

401k plan membership statisitcs for WDFG HEALTH AND WELFARE PLAN

Measure Date Value
2014: WDFG HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 1,436
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 1,217
Number of retired or separated participants receiving benefits 2014-09-01 2
Number of other retired or separated participants entitled to future benefits 2014-09-01 0
Total of all active and inactive participants 2014-09-01 1,219
2013: WDFG HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 1,329
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 1,434
Number of retired or separated participants receiving benefits 2013-09-01 2
Number of other retired or separated participants entitled to future benefits 2013-09-01 0
Total of all active and inactive participants 2013-09-01 1,436

Measure	Date	Value
2014: WDFG HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	1,436
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	1,217
Number of retired or separated participants receiving benefits	2014-09-01	2
Number of other retired or separated participants entitled to future benefits	2014-09-01	0
Total of all active and inactive participants	2014-09-01	1,219
2013: WDFG HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	1,329
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	1,434
Number of retired or separated participants receiving benefits	2013-09-01	2
Number of other retired or separated participants entitled to future benefits	2013-09-01	0
Total of all active and inactive participants	2013-09-01	1,436

Form 5500 Responses for WDFG HEALTH AND WELFARE PLAN

2014: WDFG HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Submission has been amended	No
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: WDFG HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	First time form 5500 has been submitted	Yes
2013-09-01	Submission has been amended	No
2013-09-01	This submission is the final filing	No
2013-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-09-01	Plan is a collectively bargained plan	No
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )

Policy contract number

67020

Policy instance

Insurance contract or identification number	67020
Number of Individuals Covered	423
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $120,046
Total amount of fees paid to insurance company	USD $39,197
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $3,429,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $120,046
Amount paid for insurance broker fees	39197
Additional information about fees paid to insurance broker	FEES AND ADDITIONAL COMMISSIONS PAI
Insurance broker organization code?	3
Insurance broker name	WILLIS OF MARYLAND - HUNT VALLEY

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0153764

Policy instance

Insurance contract or identification number	0153764
Number of Individuals Covered	1193
Insurance policy start date	2014-10-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $32,373
Total amount of fees paid to insurance company	USD $6,056
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $405,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,373
Amount paid for insurance broker fees	6037
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH & BENEFITS LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30041723

Policy instance

Insurance contract or identification number	30041723
Number of Individuals Covered	268
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $1,358
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	Yes
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 $226
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH & BENEFITS, LLC

GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )

Policy contract number

67020

Policy instance

Insurance contract or identification number	67020
Number of Individuals Covered	376
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $88,413
Total amount of fees paid to insurance company	USD $350,161
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	Yes
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $2,947,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,413
Amount paid for insurance broker fees	350161
Additional information about fees paid to insurance broker	MEDICAL & DENTAL CONTRACTS X PCPM NON-MONETARY INCENTIVE
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH & BENEFITS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

153764

Policy instance

Insurance contract or identification number	153764
Number of Individuals Covered	606
Insurance policy start date	2013-09-07
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $34,300
Total amount of fees paid to insurance company	USD $9,054
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $466,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,236
Amount paid for insurance broker fees	8313
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF MARYLAND INC.

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Company Name:	WDFG NORTH AMERICA, LLC
Employer identification number (EIN):	260840731
NAIC Classification:	453220
NAIC Description:	Gift, Novelty, and Souvenir Stores

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:	2013-07-09
Company Identification Number:	4427934
Legal Registered Office Address:	80 State Street Albany United States of America (USA) 12207