401k Plan data: PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE plan

PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE 401k Plan overview

Plan Name	PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE
Plan identification number	503

PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

DR. SCHNEIDER AUTOMOTIVE SYSTEMS INC. has sponsored the creation of one or more 401k plans.

Company Name: DR. SCHNEIDER AUTOMOTIVE SYSTEMS INC.

Employer identification number (EIN): 383540677

NAIC Classification: 811110
NAIC Description: Automotive Mechanical and Electrical Repair and Maintenance

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-12-01 TORSTEN LANGGUTH
503 2014-12-01 JANA ALEXYOVA JANA ALEXYOVA 2016-09-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2015-12-01	TORSTEN LANGGUTH
503	2014-12-01	JANA ALEXYOVA		JANA ALEXYOVA	2016-09-14

Plan Statistics for PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE

401k plan membership statisitcs for PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE

Measure Date Value
2015: PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE 2015 401k membership
Total participants, beginning-of-year 2015-12-01 129
Total number of active participants reported on line 7a of the Form 5500 2015-12-01 0
Number of retired or separated participants receiving benefits 2015-12-01 0
Number of other retired or separated participants entitled to future benefits 2015-12-01 0
Total of all active and inactive participants 2015-12-01 0
2014: PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE 2014 401k membership
Total participants, beginning-of-year 2014-12-01 129
Total number of active participants reported on line 7a of the Form 5500 2014-12-01 129
Number of retired or separated participants receiving benefits 2014-12-01 0
Number of other retired or separated participants entitled to future benefits 2014-12-01 0
Total of all active and inactive participants 2014-12-01 129

Measure	Date	Value
2015: PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE 2015 401k membership
Total participants, beginning-of-year	2015-12-01	129
Total number of active participants reported on line 7a of the Form 5500	2015-12-01	0
Number of retired or separated participants receiving benefits	2015-12-01	0
Number of other retired or separated participants entitled to future benefits	2015-12-01	0
Total of all active and inactive participants	2015-12-01	0
2014: PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE 2014 401k membership
Total participants, beginning-of-year	2014-12-01	129
Total number of active participants reported on line 7a of the Form 5500	2014-12-01	129
Number of retired or separated participants receiving benefits	2014-12-01	0
Number of other retired or separated participants entitled to future benefits	2014-12-01	0
Total of all active and inactive participants	2014-12-01	129

Form 5500 Responses for PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE

2015: PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	Submission has been amended	No
2015-12-01	This submission is the final filing	Yes
2015-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-12-01	Plan is a collectively bargained plan	No
2015-12-01	Plan funding arrangement – Insurance	Yes
2015-12-01	Plan benefit arrangement – Insurance	Yes
2014: PRINCIPAL DENTAL, DISABILITY AND LIFE INSURANCE 2014 form 5500 responses
2014-12-01	Type of plan entity	Single employer plan
2014-12-01	First time form 5500 has been submitted	Yes
2014-12-01	Submission has been amended	No
2014-12-01	This submission is the final filing	No
2014-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-12-01	Plan is a collectively bargained plan	No
2014-12-01	Plan funding arrangement – Insurance	Yes
2014-12-01	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

1048622

Policy instance

Insurance contract or identification number	1048622
Number of Individuals Covered	217
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $3,336
Total amount of fees paid to insurance company	USD $3,468
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	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $63,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,336
Insurance broker organization code?	3
Amount paid for insurance broker fees	3468
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	PAYCHEX INSURANCE AGENCY, INC.

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Company Name:	DR. SCHNEIDER AUTOMOTIVE SYSTEMS INC.
Employer identification number (EIN):	383540677
NAIC Classification:	811110
NAIC Description:	Automotive Mechanical and Electrical Repair and Maintenance