401k Plan data: LINDY MANUFACTURING CO. 401(K) PLAN plan

LINDY MANUFACTURING CO. 401(K) PLAN 401k Plan overview

Plan Name	LINDY MANUFACTURING CO. 401(K) PLAN
Plan identification number	001

LINDY MANUFACTURING CO. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

LINDY MANUFACTURING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: LINDY MANUFACTURING COMPANY

Employer identification number (EIN): 366115053

NAIC Classification: 332110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LINDY MANUFACTURING CO. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 DAVID COLLINS 2017-10-11 DAVID COLLINS 2017-10-11
001 2015-01-01 HOLLY BARAJAS 2016-06-27
001 2014-01-01 PATRICIA KASZA
001 2013-01-01 PATRICIA KASZA
001 2012-01-01 PATRICIA KASZA
001 2011-01-01 PATRICIA KASZA
001 2009-01-01 PATRICIA KASZA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	DAVID COLLINS	2017-10-11	DAVID COLLINS	2017-10-11
001	2015-01-01	HOLLY BARAJAS	2016-06-27
001	2014-01-01	PATRICIA KASZA
001	2013-01-01	PATRICIA KASZA
001	2012-01-01	PATRICIA KASZA
001	2011-01-01	PATRICIA KASZA
001	2009-01-01	PATRICIA KASZA

Plan Statistics for LINDY MANUFACTURING CO. 401(K) PLAN

401k plan membership statisitcs for LINDY MANUFACTURING CO. 401(K) PLAN

Measure Date Value
2014: LINDY MANUFACTURING CO. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 14
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 7
Total of all active and inactive participants 2014-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 22
Number of participants with account balances 2014-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: LINDY MANUFACTURING CO. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 20
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 5
Total of all active and inactive participants 2013-01-01 26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 26
Number of participants with account balances 2013-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: LINDY MANUFACTURING CO. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 19
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 5
Total of all active and inactive participants 2012-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 24
Number of participants with account balances 2012-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: LINDY MANUFACTURING CO. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 21
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 21
Number of participants with account balances 2011-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: LINDY MANUFACTURING CO. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 34
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 1
Total of all active and inactive participants 2009-01-01 35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 35
Number of participants with account balances 2009-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2014: LINDY MANUFACTURING CO. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	14
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	7
Total of all active and inactive participants	2014-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	22
Number of participants with account balances	2014-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: LINDY MANUFACTURING CO. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	20
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	5
Total of all active and inactive participants	2013-01-01	26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	26
Number of participants with account balances	2013-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: LINDY MANUFACTURING CO. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	19
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	5
Total of all active and inactive participants	2012-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	24
Number of participants with account balances	2012-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: LINDY MANUFACTURING CO. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	21
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	21
Number of participants with account balances	2011-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: LINDY MANUFACTURING CO. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	34
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	1
Total of all active and inactive participants	2009-01-01	35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	35
Number of participants with account balances	2009-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on LINDY MANUFACTURING CO. 401(K) PLAN

Measure	Date	Value
2014 : LINDY MANUFACTURING CO. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$64,287
Expenses. Total of all expenses incurred	2014-12-31	$94,010
Benefits paid (including direct rollovers)	2014-12-31	$93,788
Total plan assets at end of year	2014-12-31	$497,343
Total plan assets at beginning of year	2014-12-31	$527,066
Value of fidelity bond covering the plan	2014-12-31	$65,000
Total contributions received or receivable from participants	2014-12-31	$40,054
Expenses. Other expenses not covered elsewhere	2014-12-31	$222
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$24,233
Net income (gross income less expenses)	2014-12-31	$-29,723
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$497,343
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$527,066
Assets. Value of participant loans	2014-12-31	$12,617
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : LINDY MANUFACTURING CO. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$112,919
Expenses. Total of all expenses incurred	2013-12-31	$319,908
Benefits paid (including direct rollovers)	2013-12-31	$319,832
Total plan assets at end of year	2013-12-31	$527,067
Total plan assets at beginning of year	2013-12-31	$734,056
Value of fidelity bond covering the plan	2013-12-31	$65,000
Total contributions received or receivable from participants	2013-12-31	$36,353
Expenses. Other expenses not covered elsewhere	2013-12-31	$76
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$76,566
Net income (gross income less expenses)	2013-12-31	$-206,989
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$527,067
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$734,056
Assets. Value of participant loans	2013-12-31	$20,401
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : LINDY MANUFACTURING CO. 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$126,742
Expenses. Total of all expenses incurred	2012-12-31	$139,328
Benefits paid (including direct rollovers)	2012-12-31	$139,102
Total plan assets at end of year	2012-12-31	$734,056
Total plan assets at beginning of year	2012-12-31	$746,642
Value of fidelity bond covering the plan	2012-12-31	$65,000
Total contributions received or receivable from participants	2012-12-31	$47,315
Expenses. Other expenses not covered elsewhere	2012-12-31	$226
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$79,427
Net income (gross income less expenses)	2012-12-31	$-12,586
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$734,056
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$746,642
Assets. Value of participant loans	2012-12-31	$30,094
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : LINDY MANUFACTURING CO. 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$37,301
Expenses. Total of all expenses incurred	2011-12-31	$68,239
Benefits paid (including direct rollovers)	2011-12-31	$67,969
Total plan assets at end of year	2011-12-31	$746,642
Total plan assets at beginning of year	2011-12-31	$777,580
Value of fidelity bond covering the plan	2011-12-31	$65,000
Total contributions received or receivable from participants	2011-12-31	$48,480
Expenses. Other expenses not covered elsewhere	2011-12-31	$270
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-11,179
Net income (gross income less expenses)	2011-12-31	$-30,938
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$746,642
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$777,580
Assets. Value of participant loans	2011-12-31	$40,516
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : LINDY MANUFACTURING CO. 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$116,753
Expenses. Total of all expenses incurred	2010-12-31	$97,795
Benefits paid (including direct rollovers)	2010-12-31	$97,517
Total plan assets at end of year	2010-12-31	$777,580
Total plan assets at beginning of year	2010-12-31	$758,622
Value of fidelity bond covering the plan	2010-12-31	$65,000
Total contributions received or receivable from participants	2010-12-31	$43,675
Expenses. Other expenses not covered elsewhere	2010-12-31	$278
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$73,078
Net income (gross income less expenses)	2010-12-31	$18,958
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$777,580
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$758,622
Assets. Value of participant loans	2010-12-31	$29,815
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : LINDY MANUFACTURING CO. 401(K) PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for LINDY MANUFACTURING CO. 401(K) PLAN

2014: LINDY MANUFACTURING CO. 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: LINDY MANUFACTURING CO. 401(K) 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 funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: LINDY MANUFACTURING CO. 401(K) 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 funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: LINDY MANUFACTURING CO. 401(K) 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: LINDY MANUFACTURING CO. 401(K) 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 funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-800042

Policy instance

Insurance contract or identification number	GA-800042
Number of Individuals Covered	20
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,070
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?	Yes
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 $2,070
Insurance broker organization code?	3
Insurance broker name	NFP SECURITIES INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-800042

Policy instance

Insurance contract or identification number	GA-800042
Number of Individuals Covered	21
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,986
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?	Yes
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 $1,986
Insurance broker organization code?	3
Insurance broker name	NFP SECURITIES INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-800042

Policy instance

Insurance contract or identification number	GA-800042
Number of Individuals Covered	21
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,231
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?	Yes
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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-800042

Policy instance

Insurance contract or identification number	GA-800042
Number of Individuals Covered	24
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,159
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?	Yes
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

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Company Name:	LINDY MANUFACTURING COMPANY
Employer identification number (EIN):	366115053
NAIC Classification:	332110