401k Plan data: LEVER1 LIFE AND AD&D INSURANCE PLAN plan

LEVER1 LIFE AND AD&D INSURANCE PLAN 401k Plan overview

Plan Name	LEVER1 LIFE AND AD&D INSURANCE PLAN
Plan identification number	501

LEVER1 LIFE AND AD&D INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

LEVER1 has sponsored the creation of one or more 401k plans.

Company Name: LEVER1

Employer identification number (EIN): 454152888

NAIC Classification: 541214
NAIC Description: Payroll Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEVER1 LIFE AND AD&D INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 ERICA BRUNE
501 2015-01-01 ERICA BRUNE
501 2014-01-01 ERICA BRUNE

Plan id#	Filing Submission Date	Name of Administrator
501	2015-01-01	ERICA BRUNE
501	2015-01-01	ERICA BRUNE
501	2014-01-01	ERICA BRUNE

Plan Statistics for LEVER1 LIFE AND AD&D INSURANCE PLAN

401k plan membership statisitcs for LEVER1 LIFE AND AD&D INSURANCE PLAN

Measure Date Value
2015: LEVER1 LIFE AND AD&D INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 214
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 212
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 212
2014: LEVER1 LIFE AND AD&D INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 214
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 214
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 214

Measure	Date	Value
2015: LEVER1 LIFE AND AD&D INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	214
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	212
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	212
2014: LEVER1 LIFE AND AD&D INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	214
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	214
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	214

Form 5500 Responses for LEVER1 LIFE AND AD&D INSURANCE PLAN

2015: LEVER1 LIFE AND AD&D INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: LEVER1 LIFE AND AD&D INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple employer plan
2014-01-01	First time form 5500 has been submitted	Yes
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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010108241

Policy instance

Insurance contract or identification number	000010108241
Number of Individuals Covered	212
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,428
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
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 $7,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,428
Insurance broker organization code?	3
Insurance broker name	HERITAGE BENEFIT CONSULTANTS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010108241

Policy instance

Insurance contract or identification number	000010108241
Number of Individuals Covered	214
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,246
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
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 $6,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,035
Insurance broker organization code?	3
Insurance broker name	SCOTT B LEPLEY

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Company Name:	LEVER1
Employer identification number (EIN):	454152888
NAIC Classification:	541214
NAIC Description:	Payroll Services