401k Plan data: ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN plan

ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN
Plan identification number	511

ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

ANDERSON MACHINING SERVICE LLC has sponsored the creation of one or more 401k plans.

Company Name: ANDERSON MACHINING SERVICE LLC

Employer identification number (EIN): 320469463

NAIC Classification: 332700

Additional information about ANDERSON MACHINING SERVICE LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5775638

More information about ANDERSON MACHINING SERVICE LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
511 2015-11-01 CORINA ANDERSON CORINA ANDERSON 2016-05-04
511 2014-11-01 CORINA ANDERSON CORINA ANDERSON 2016-05-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
511	2015-11-01	CORINA ANDERSON		CORINA ANDERSON	2016-05-04
511	2014-11-01	CORINA ANDERSON		CORINA ANDERSON	2016-05-01

Plan Statistics for ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN

Measure Date Value
2015: ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-11-01 104
Total number of active participants reported on line 7a of the Form 5500 2015-11-01 55
Total of all active and inactive participants 2015-11-01 55
Total participants 2015-11-01 55
2014: ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-11-01 103
Total number of active participants reported on line 7a of the Form 5500 2014-11-01 104
Total of all active and inactive participants 2014-11-01 104
Total participants 2014-11-01 104

Measure	Date	Value
2015: ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-11-01	104
Total number of active participants reported on line 7a of the Form 5500	2015-11-01	55
Total of all active and inactive participants	2015-11-01	55
Total participants	2015-11-01	55
2014: ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-11-01	103
Total number of active participants reported on line 7a of the Form 5500	2014-11-01	104
Total of all active and inactive participants	2014-11-01	104
Total participants	2014-11-01	104

Form 5500 Responses for ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN

2015: ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-11-01	Type of plan entity	Single employer plan
2015-11-01	First time form 5500 has been submitted	Yes
2015-11-01	Submission has been amended	No
2015-11-01	This submission is the final filing	No
2015-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-11-01	Plan is a collectively bargained plan	No
2015-11-01	Plan funding arrangement – Insurance	Yes
2015-11-01	Plan benefit arrangement – Insurance	Yes
2014: ANDERSON MACHINING SERVICE LLC WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-11-01	Type of plan entity	Single employer plan
2014-11-01	First time form 5500 has been submitted	Yes
2014-11-01	Submission has been amended	No
2014-11-01	This submission is the final filing	No
2014-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-11-01	Plan is a collectively bargained plan	No
2014-11-01	Plan funding arrangement – Insurance	Yes
2014-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1008720

Policy instance

Insurance contract or identification number	1008720
Number of Individuals Covered	105
Insurance policy start date	2015-11-01
Insurance policy end date	2016-01-31
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	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $4,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1008720

Policy instance

Insurance contract or identification number	1008720
Number of Individuals Covered	192
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $4,934
Total amount of fees paid to insurance company	USD $5,272
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	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $100,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	510
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,934
Insurance broker name	INSURANCE & INVESTMENT PROFESSIONAL

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Company Name:	ANDERSON MACHINING SERVICE LLC
Employer identification number (EIN):	320469463
NAIC Classification:	332700

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5775638