401k Plan data: GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN plan

GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN 401k Plan overview

Plan Name	GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN
Plan identification number	517

GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

GRAY PLANT MOOTY MOOTY AND BENNETT PA has sponsored the creation of one or more 401k plans.

Company Name: GRAY PLANT MOOTY MOOTY AND BENNETT PA

Employer identification number (EIN): 411411978

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
517 2019-01-01
517 2018-01-01

Plan Statistics for GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN

401k plan membership statisitcs for GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN

Measure Date Value
2019: GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 136
Total of all active and inactive participants 2019-01-01 136
Total participants 2019-01-01 136
2018: GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 148
Total of all active and inactive participants 2018-01-01 148
Total participants 2018-01-01 148

Measure	Date	Value
2019: GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	136
Total of all active and inactive participants	2019-01-01	136
Total participants	2019-01-01	136
2018: GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	148
Total of all active and inactive participants	2018-01-01	148
Total participants	2018-01-01	148

Form 5500 Responses for GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN

2019: GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: GRAY PLANT MOOTY MOOTY AND BENNETT PA VISION PLAN 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

Insurance Providers Used on plan

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

Policy contract number

10079971001

Policy instance

Insurance contract or identification number	10079971001
Number of Individuals Covered	136
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,342
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 $12,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10079971001

Policy instance

Insurance contract or identification number	10079971001
Number of Individuals Covered	148
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,546
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 $15,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,546
Insurance broker organization code?	3

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Company Name:	GRAY PLANT MOOTY MOOTY AND BENNETT PA
Employer identification number (EIN):	411411978
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers