401k Plan data: NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN plan

NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN 401k Plan overview

Plan Name	NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN
Plan identification number	502

NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN Benefits

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

401k Sponsoring company profile

HORMANN NORTHWEST DOOR, LLC has sponsored the creation of one or more 401k plans.

Company Name: HORMANN NORTHWEST DOOR, LLC

Employer identification number (EIN): 474725688

NAIC Classification: 423990
NAIC Description: Other Miscellaneous Durable Goods Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-09-01 PATTI HIGH
502 2015-09-01 PATTI HIGH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2015-09-01	PATTI HIGH
502	2015-09-01	PATTI HIGH

Plan Statistics for NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN

401k plan membership statisitcs for NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN

Measure Date Value
2015: NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 224
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 238
Number of retired or separated participants receiving benefits 2015-09-01 0
Number of other retired or separated participants entitled to future benefits 2015-09-01 0
Total of all active and inactive participants 2015-09-01 238

Measure	Date	Value
2015: NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	224
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	238
Number of retired or separated participants receiving benefits	2015-09-01	0
Number of other retired or separated participants entitled to future benefits	2015-09-01	0
Total of all active and inactive participants	2015-09-01	238

Form 5500 Responses for NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN

2015: NORTHWEST DOOR LLC LIFE, AD&D AND LTD PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	First time form 5500 has been submitted	Yes
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

212527

Policy instance

Insurance contract or identification number	212527
Number of Individuals Covered	238
Insurance policy start date	2015-09-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $2,992
Total amount of fees paid to insurance company	USD $424
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 $19,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,992
Insurance broker organization code?	3
Amount paid for insurance broker fees	424
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	M FINANCIAL HOLDINGS, INC.

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Company Name:	HORMANN NORTHWEST DOOR, LLC
Employer identification number (EIN):	474725688
NAIC Classification:	423990
NAIC Description:	Other Miscellaneous Durable Goods Merchant Wholesalers