401k Plan data: PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN plan

PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN 401k Plan overview

Plan Name	PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN
Plan identification number	502

PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN Benefits

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

401k Sponsoring company profile

PRIDE ROCK CAPITAL MANAGEMENT has sponsored the creation of one or more 401k plans.

Company Name: PRIDE ROCK CAPITAL MANAGEMENT

Employer identification number (EIN): 262415741

NAIC Classification: 531310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01 CHRISTINA WILLETTE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2017-01-01	CHRISTINA WILLETTE

Plan Statistics for PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN

401k plan membership statisitcs for PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN

Measure Date Value
2017: PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 230
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 230

Measure	Date	Value
2017: PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	230
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	230

Form 5500 Responses for PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN

2017: PRIDEROCK CAPITAL PARTNERS, LLC HEALTH PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0613018

Policy instance

Insurance contract or identification number	0613018
Number of Individuals Covered	236
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,133
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	No
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $143,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,133
Insurance broker organization code?	3
Insurance broker name	CRYSTAL IBC LLC

Potentially related plans

PRIDEROCK CAPITAL PARTNERS, LLC 401 K PROFIT SHARING PLAN TRUST [EIN = 263046407]

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Company Name:	PRIDE ROCK CAPITAL MANAGEMENT
Employer identification number (EIN):	262415741
NAIC Classification:	531310