401k Plan data: PORT CITY GROUP WELFARE BENEFITS PLAN plan

PORT CITY GROUP WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	PORT CITY GROUP WELFARE BENEFITS PLAN
Plan identification number	501

PORT CITY GROUP WELFARE BENEFITS PLAN 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 Other welfare benefit cover

401k Sponsoring company profile

PORT CITY GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: PORT CITY GROUP, INC.

Employer identification number (EIN): 455136598

NAIC Classification: 336300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PORT CITY GROUP WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 DALE KEYSER
501 2016-01-01 JIM HURLEY
501 2015-01-01 JIM HURLEY
501 2014-01-01 DALE KEYSER
501 2013-01-01 DALE KEYSER

Plan id#	Filing Submission Date	Name of Administrator
501	2017-01-01	DALE KEYSER
501	2016-01-01	JIM HURLEY
501	2015-01-01	JIM HURLEY
501	2014-01-01	DALE KEYSER
501	2013-01-01	DALE KEYSER

Plan Statistics for PORT CITY GROUP WELFARE BENEFITS PLAN

401k plan membership statisitcs for PORT CITY GROUP WELFARE BENEFITS PLAN

Measure Date Value
2017: PORT CITY GROUP WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 452
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 382
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 382
2016: PORT CITY GROUP WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 401
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 452
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 452
2015: PORT CITY GROUP WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 345
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 401
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 2015-01-01 401
2014: PORT CITY GROUP WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 492
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 345
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 346
2013: PORT CITY GROUP WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 386
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 492
Number of retired or separated participants receiving benefits 2013-01-01 1
Total of all active and inactive participants 2013-01-01 493

Measure	Date	Value
2017: PORT CITY GROUP WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	452
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	382
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	382
2016: PORT CITY GROUP WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	401
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	452
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	452
2015: PORT CITY GROUP WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	345
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	401
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	401
2014: PORT CITY GROUP WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	492
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	345
Number of retired or separated participants receiving benefits	2014-01-01	1
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	346
2013: PORT CITY GROUP WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	386
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	492
Number of retired or separated participants receiving benefits	2013-01-01	1
Total of all active and inactive participants	2013-01-01	493

Form 5500 Responses for PORT CITY GROUP WELFARE BENEFITS PLAN

2017: PORT CITY GROUP WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: PORT CITY GROUP WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: PORT CITY GROUP WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: PORT CITY GROUP WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: PORT CITY GROUP WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12278381

Policy instance

Insurance contract or identification number	12278381
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,290
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $692
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE, INC.

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

CLI196260

Policy instance

Insurance contract or identification number	CLI196260
Number of Individuals Covered	382
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $21,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,696
Insurance broker organization code?	3
Insurance broker name	ASR HEALTH BENEFITS

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

690425-0GL

Policy instance

Insurance contract or identification number	690425-0GL
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $-95
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-95
Insurance broker organization code?	3
Insurance broker name	LIGHTHOUSE KEUNING INS GRP INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

690425-GLT

Policy instance

Insurance contract or identification number	690425-GLT
Number of Individuals Covered	123
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	LIGHTHOUSE KEUNING IN GRP INC

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0004430

Policy instance

Insurance contract or identification number	0004430
Number of Individuals Covered	715
Insurance policy start date	2017-01-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $3,446
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,446
Insurance broker organization code?	3
Insurance broker name	LIGHTHOUSE-KEUNING INSURANCE GROUP

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

690425-GLT

Policy instance

Insurance contract or identification number	690425-GLT
Number of Individuals Covered	153
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,399
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,399
Insurance broker organization code?	3
Insurance broker name	LIGHTHOUSE KEUNING IN GRP INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

690425-0GL

Policy instance

Insurance contract or identification number	690425-0GL
Number of Individuals Covered	537
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,679
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,679
Insurance broker organization code?	3
Insurance broker name	LIGHTHOUSE KEUNING INS GRP INC

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

CLI196260

Policy instance

Insurance contract or identification number	CLI196260
Number of Individuals Covered	404
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $13,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,009
Insurance broker organization code?	3
Insurance broker name	ASR HEALTH BENEFITS

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12278381

Policy instance

Insurance contract or identification number	12278381
Number of Individuals Covered	308
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,847
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,847
Insurance broker organization code?	3
Insurance broker name	LIGHTHOUSE INSURANCE GROUP

ASR CORPORATION (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

16-012593-00

Policy instance

Insurance contract or identification number	16-012593-00
Number of Individuals Covered	404
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $59
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59
Insurance broker organization code?	3
Insurance broker name	ASR HEALTH BENEFITS

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0004430

Policy instance

Insurance contract or identification number	0004430
Number of Individuals Covered	785
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,998
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,998
Insurance broker organization code?	3
Insurance broker name	LIGHTHOUSE-KEUNING INSURANCE GROUP

ASR CORPORATION (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

16-012593-00

Policy instance

Insurance contract or identification number	16-012593-00
Number of Individuals Covered	338
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,447
Insurance broker organization code?	3
Insurance broker name	ASR HEALTH BENEFITS

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0004430

Policy instance

Insurance contract or identification number	0004430
Number of Individuals Covered	773
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,044
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,811
Insurance broker organization code?	3
Insurance broker name	USI MIDWEST INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

690425-GLT

Policy instance

Insurance contract or identification number	690425-GLT
Number of Individuals Covered	499
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,305
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,695
Insurance broker organization code?	3
Insurance broker name	USI MIDWEST INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

690425-0GL

Policy instance

Insurance contract or identification number	690425-0GL
Number of Individuals Covered	153
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,575
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,247
Insurance broker organization code?	3
Insurance broker name	USI MIDWEST INC

WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )

Policy contract number

0655540

Policy instance

Insurance contract or identification number	0655540
Number of Individuals Covered	322
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,758
Insurance broker organization code?	3
Insurance broker name	ASR HEALTH BENEFITS

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12278381

Policy instance

Insurance contract or identification number	12278381
Number of Individuals Covered	301
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,823
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $956
Insurance broker organization code?	3
Insurance broker name	LIGHTHOUSE INSURANCE GROUP

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12278381

Policy instance

Insurance contract or identification number	12278381
Number of Individuals Covered	285
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,820
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,524
Insurance broker name	WELLS FARGO USA

WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )

Policy contract number

0655540

Policy instance

Insurance contract or identification number	0655540
Number of Individuals Covered	323
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $67,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67,353
Insurance broker name	ASR HEALTH BENEFITS

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

690425-0GL

Policy instance

Insurance contract or identification number	690425-0GL
Number of Individuals Covered	140
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,470
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,470
Insurance broker name	WELLS FARGO

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

690425-GLT

Policy instance

Insurance contract or identification number	690425-GLT
Number of Individuals Covered	498
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,065
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,048
Insurance broker name	DAVID YOUNG

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0004430

Policy instance

Insurance contract or identification number	0004430
Number of Individuals Covered	802
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,080
Total amount of fees paid to insurance company	USD $16,339
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,080
Amount paid for insurance broker fees	16339
Insurance broker name	WELLS FARGO

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Company Name:	PORT CITY GROUP, INC.
Employer identification number (EIN):	455136598
NAIC Classification:	336300