401k Plan data: AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN plan

AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN 401k Plan overview

Plan Name	AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN
Plan identification number	501

AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

AMERICAN CONVERTERS, INC. has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN CONVERTERS, INC.

Employer identification number (EIN): 411284688

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 DAVID NYPOWER DAVID NYPOWER 2018-06-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2017-01-01	DAVID NYPOWER		DAVID NYPOWER	2018-06-01

Plan Statistics for AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN

401k plan membership statisitcs for AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN

Measure Date Value
2017: AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 146
Number of retired or separated participants receiving benefits 2017-01-01 2
Total of all active and inactive participants 2017-01-01 148

Measure	Date	Value
2017: AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	146
Number of retired or separated participants receiving benefits	2017-01-01	2
Total of all active and inactive participants	2017-01-01	148

Form 5500 Responses for AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN

2017: AMERICAN CONVERTERS INC GROUP BENEFITS WRAP PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )

Policy contract number

13773

Policy instance

Insurance contract or identification number	13773
Number of Individuals Covered	148
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $31,652
Total amount of fees paid to insurance company	USD $2,477
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $725,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,652
Amount paid for insurance broker fees	2477
Additional information about fees paid to insurance broker	MARKETING ALLOWANCE
Insurance broker organization code?	3
Insurance broker name	MARCH & MCLENNAN AGENCY LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05913253

Policy instance

Insurance contract or identification number	KM05913253
Number of Individuals Covered	118
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,400
Total amount of fees paid to insurance company	USD $723
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,400
Amount paid for insurance broker fees	723
Additional information about fees paid to insurance broker	MARKETING ALLOWANCE
Insurance broker organization code?	3
Insurance broker name	MARCH & MCLENNAN AGENCY LLC

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

Policy contract number

10032431001

Policy instance

Insurance contract or identification number	10032431001
Number of Individuals Covered	44
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $394
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $394
Insurance broker organization code?	3
Insurance broker name	MARCH & MCLENNAN AGENCY LLC

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Company Name:	AMERICAN CONVERTERS, INC.
Employer identification number (EIN):	411284688
NAIC Classification:	339900