401k Plan data: TENIBAC GRAPHION INC, EMPLOYER PAID LINES plan

TENIBAC GRAPHION INC, EMPLOYER PAID LINES 401k Plan overview

Plan Name	TENIBAC GRAPHION INC, EMPLOYER PAID LINES
Plan identification number	501

TENIBAC GRAPHION INC, EMPLOYER PAID LINES 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) Other welfare benefit cover

401k Sponsoring company profile

TENIBAC-GRAPHION, INC. has sponsored the creation of one or more 401k plans.

Company Name: TENIBAC-GRAPHION, INC.

Employer identification number (EIN): 382093516

NAIC Classification: 332810

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TENIBAC GRAPHION INC, EMPLOYER PAID LINES

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-01-01
501 2009-04-01 BILL ARMS

Plan Statistics for TENIBAC GRAPHION INC, EMPLOYER PAID LINES

401k plan membership statisitcs for TENIBAC GRAPHION INC, EMPLOYER PAID LINES

Measure Date Value
2018: TENIBAC GRAPHION INC, EMPLOYER PAID LINES 2018 401k membership
Total participants, beginning-of-year 2018-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 108
Total of all active and inactive participants 2018-01-01 108
Total participants 2018-01-01 108
2009: TENIBAC GRAPHION INC, EMPLOYER PAID LINES 2009 401k membership
Total participants, beginning-of-year 2009-04-01 92
Total number of active participants reported on line 7a of the Form 5500 2009-04-01 93
Total of all active and inactive participants 2009-04-01 93
Total participants 2009-04-01 93

Measure	Date	Value
2018: TENIBAC GRAPHION INC, EMPLOYER PAID LINES 2018 401k membership
Total participants, beginning-of-year	2018-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	108
Total of all active and inactive participants	2018-01-01	108
Total participants	2018-01-01	108
2009: TENIBAC GRAPHION INC, EMPLOYER PAID LINES 2009 401k membership
Total participants, beginning-of-year	2009-04-01	92
Total number of active participants reported on line 7a of the Form 5500	2009-04-01	93
Total of all active and inactive participants	2009-04-01	93
Total participants	2009-04-01	93

Form 5500 Responses for TENIBAC GRAPHION INC, EMPLOYER PAID LINES

2018: TENIBAC GRAPHION INC, EMPLOYER PAID LINES 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2009: TENIBAC GRAPHION INC, EMPLOYER PAID LINES 2009 form 5500 responses
2009-04-01	Type of plan entity	Single employer plan
2009-04-01	First time form 5500 has been submitted	Yes
2009-04-01	Submission has been amended	No
2009-04-01	This submission is the final filing	No
2009-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-04-01	Plan is a collectively bargained plan	No
2009-04-01	Plan funding arrangement – Insurance	Yes
2009-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98597451001

Policy instance

Insurance contract or identification number	98597451001
Number of Individuals Covered	157
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,724
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	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 $10,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,724

ALLIANCE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60134 )

Policy contract number

10001164

Policy instance

Insurance contract or identification number	10001164
Number of Individuals Covered	157
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $31,639
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	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 $802,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,639

HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )

Policy contract number

10002728

Policy instance

Insurance contract or identification number	10002728
Number of Individuals Covered	64
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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	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 $301,605
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

1030916

Policy instance

Insurance contract or identification number	1030916
Number of Individuals Covered	253
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $9,838
Total amount of fees paid to insurance company	USD $1,208
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	No
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 $130,194
Commission paid to Insurance Broker	USD $9,838
Amount paid for insurance broker fees	1208
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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Company Name:	TENIBAC-GRAPHION, INC.
Employer identification number (EIN):	382093516
NAIC Classification:	332810