401k Plan data: SUMNERONE, INC. SHORT-TERM DISABILITY PLAN plan

SUMNERONE, INC. SHORT-TERM DISABILITY PLAN 401k Plan overview

Plan Name	SUMNERONE, INC. SHORT-TERM DISABILITY PLAN
Plan identification number	506

SUMNERONE, INC. SHORT-TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness)

401k Sponsoring company profile

RELIANCE STANDARD LIFE INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY

Employer identification number (EIN): 360883760

NAIC Classification: 524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUMNERONE, INC. SHORT-TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2016-01-01

Plan Statistics for SUMNERONE, INC. SHORT-TERM DISABILITY PLAN

401k plan membership statisitcs for SUMNERONE, INC. SHORT-TERM DISABILITY PLAN

Measure Date Value
2016: SUMNERONE, INC. SHORT-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 33
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 33

Measure	Date	Value
2016: SUMNERONE, INC. SHORT-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	33
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	33

Form 5500 Responses for SUMNERONE, INC. SHORT-TERM DISABILITY PLAN

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

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326629

Policy instance

Insurance contract or identification number	VPS 326629
Number of Individuals Covered	33
Insurance policy start date	2016-01-01
Insurance policy end date	2016-12-31
Total amount of commissions paid to insurance broker	USD $1,186
Total amount of fees paid to insurance company	USD $270
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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 $7,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,186
Amount paid for insurance broker fees	270
Additional information about fees paid to insurance broker	TOTAL ADMINISTRATIVE & OTHER FEES
Insurance broker organization code?	3

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Company Name:	RELIANCE STANDARD LIFE INSURANCE COMPANY
Employer identification number (EIN):	360883760
NAIC Classification:	524140