401k Plan data: ARCTIC GLACIER U. S. A., INC. plan

ARCTIC GLACIER U. S. A., INC. 401k Plan overview

Plan Name	ARCTIC GLACIER U. S. A., INC.
Plan identification number	502

ARCTIC GLACIER U. S. A., INC. Benefits

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

401k Sponsoring company profile

ARCTIC GLACIER U.S.A., INC. has sponsored the creation of one or more 401k plans.

Company Name: ARCTIC GLACIER U.S.A., INC.

Employer identification number (EIN): 460527958

NAIC Classification: 312110
NAIC Description: Soft Drink and Ice Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARCTIC GLACIER U. S. A., INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-11-01 DEBRA RODD
502 2014-11-01 DEBRA RODD
502 2013-11-01 DEBRA RODD
502 2012-11-01 TESS GARCIA

Plan id#	Filing Submission Date	Name of Administrator
502	2015-11-01	DEBRA RODD
502	2014-11-01	DEBRA RODD
502	2013-11-01	DEBRA RODD
502	2012-11-01	TESS GARCIA

Plan Statistics for ARCTIC GLACIER U. S. A., INC.

401k plan membership statisitcs for ARCTIC GLACIER U. S. A., INC.

Measure Date Value
2015: ARCTIC GLACIER U. S. A., INC. 2015 401k membership
Total participants, beginning-of-year 2015-11-01 394
Total number of active participants reported on line 7a of the Form 5500 2015-11-01 0
Number of retired or separated participants receiving benefits 2015-11-01 0
Number of other retired or separated participants entitled to future benefits 2015-11-01 0
Total of all active and inactive participants 2015-11-01 0
2014: ARCTIC GLACIER U. S. A., INC. 2014 401k membership
Total participants, beginning-of-year 2014-11-01 451
Total number of active participants reported on line 7a of the Form 5500 2014-11-01 394
Number of retired or separated participants receiving benefits 2014-11-01 0
Number of other retired or separated participants entitled to future benefits 2014-11-01 0
Total of all active and inactive participants 2014-11-01 394
2013: ARCTIC GLACIER U. S. A., INC. 2013 401k membership
Total participants, beginning-of-year 2013-11-01 650
Total number of active participants reported on line 7a of the Form 5500 2013-11-01 637
Number of retired or separated participants receiving benefits 2013-11-01 0
Number of other retired or separated participants entitled to future benefits 2013-11-01 0
Total of all active and inactive participants 2013-11-01 637
2012: ARCTIC GLACIER U. S. A., INC. 2012 401k membership
Total participants, beginning-of-year 2012-11-01 702
Total number of active participants reported on line 7a of the Form 5500 2012-11-01 650
Number of retired or separated participants receiving benefits 2012-11-01 0
Number of other retired or separated participants entitled to future benefits 2012-11-01 0
Total of all active and inactive participants 2012-11-01 650

Measure	Date	Value
2015: ARCTIC GLACIER U. S. A., INC. 2015 401k membership
Total participants, beginning-of-year	2015-11-01	394
Total number of active participants reported on line 7a of the Form 5500	2015-11-01	0
Number of retired or separated participants receiving benefits	2015-11-01	0
Number of other retired or separated participants entitled to future benefits	2015-11-01	0
Total of all active and inactive participants	2015-11-01	0
2014: ARCTIC GLACIER U. S. A., INC. 2014 401k membership
Total participants, beginning-of-year	2014-11-01	451
Total number of active participants reported on line 7a of the Form 5500	2014-11-01	394
Number of retired or separated participants receiving benefits	2014-11-01	0
Number of other retired or separated participants entitled to future benefits	2014-11-01	0
Total of all active and inactive participants	2014-11-01	394
2013: ARCTIC GLACIER U. S. A., INC. 2013 401k membership
Total participants, beginning-of-year	2013-11-01	650
Total number of active participants reported on line 7a of the Form 5500	2013-11-01	637
Number of retired or separated participants receiving benefits	2013-11-01	0
Number of other retired or separated participants entitled to future benefits	2013-11-01	0
Total of all active and inactive participants	2013-11-01	637
2012: ARCTIC GLACIER U. S. A., INC. 2012 401k membership
Total participants, beginning-of-year	2012-11-01	702
Total number of active participants reported on line 7a of the Form 5500	2012-11-01	650
Number of retired or separated participants receiving benefits	2012-11-01	0
Number of other retired or separated participants entitled to future benefits	2012-11-01	0
Total of all active and inactive participants	2012-11-01	650

Form 5500 Responses for ARCTIC GLACIER U. S. A., INC.

2015: ARCTIC GLACIER U. S. A., INC. 2015 form 5500 responses
2015-11-01	Type of plan entity	Single employer plan
2015-11-01	Submission has been amended	No
2015-11-01	This submission is the final filing	Yes
2015-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-11-01	Plan is a collectively bargained plan	No
2015-11-01	Plan funding arrangement – Insurance	Yes
2015-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-11-01	Plan benefit arrangement – Insurance	Yes
2015-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: ARCTIC GLACIER U. S. A., INC. 2014 form 5500 responses
2014-11-01	Type of plan entity	Single employer plan
2014-11-01	Submission has been amended	No
2014-11-01	This submission is the final filing	No
2014-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-11-01	Plan is a collectively bargained plan	No
2014-11-01	Plan funding arrangement – Insurance	Yes
2014-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-11-01	Plan benefit arrangement – Insurance	Yes
2014-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: ARCTIC GLACIER U. S. A., INC. 2013 form 5500 responses
2013-11-01	Type of plan entity	Single employer plan
2013-11-01	Submission has been amended	No
2013-11-01	This submission is the final filing	No
2013-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-11-01	Plan is a collectively bargained plan	No
2013-11-01	Plan funding arrangement – Insurance	Yes
2013-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-11-01	Plan benefit arrangement – Insurance	Yes
2013-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: ARCTIC GLACIER U. S. A., INC. 2012 form 5500 responses
2012-11-01	Type of plan entity	Single employer plan
2012-11-01	Submission has been amended	No
2012-11-01	This submission is the final filing	No
2012-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-11-01	Plan is a collectively bargained plan	No
2012-11-01	Plan funding arrangement – Insurance	Yes
2012-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-11-01	Plan benefit arrangement – Insurance	Yes
2012-11-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

10028363

Policy instance

Insurance contract or identification number	10028363
Number of Individuals Covered	610
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $0
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	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 $15,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10028363

Policy instance

Insurance contract or identification number	10028363
Number of Individuals Covered	655
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $0
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	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 $102,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10028363

Policy instance

Insurance contract or identification number	10028363
Number of Individuals Covered	637
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $16,254
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	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 $108,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,254
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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

Policy contract number

10028363

Policy instance

Insurance contract or identification number	10028363
Number of Individuals Covered	650
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $18,901
Total amount of fees paid to insurance company	USD $1,509
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	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 $126,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,901
Insurance broker organization code?	3
Amount paid for insurance broker fees	1509
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	LOCKTON COMPANIES, LLC

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Company Name:	ARCTIC GLACIER U.S.A., INC.
Employer identification number (EIN):	460527958
NAIC Classification:	312110
NAIC Description:	Soft Drink and Ice Manufacturing