401k Plan data: PETERSON PROPERTIES, INC. GROUP LIFE PLAN plan

PETERSON PROPERTIES, INC. GROUP LIFE PLAN 401k Plan overview

Plan Name	PETERSON PROPERTIES, INC. GROUP LIFE PLAN
Plan identification number	502

PETERSON PROPERTIES, INC. GROUP LIFE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

PETERSON PROPERTIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: PETERSON PROPERTIES, INC.

Employer identification number (EIN): 480919120

NAIC Classification: 531110
NAIC Description: Lessors of Residential Buildings and Dwellings

Additional information about PETERSON PROPERTIES, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1963-01-02

Company Identification Number: 153326

Legal Registered Office Address: 9 EAST MAIN ST
PO BOX 148
CORFU
United States of America (USA)
14036

More information about PETERSON PROPERTIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PETERSON PROPERTIES, INC. GROUP LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-11-01 JOHN KORNHAUS JOHN KORNHAUS 2018-01-26
502 2015-11-01 JOHN KORNHAUS JOHN KORNHAUS 2017-03-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2016-11-01	JOHN KORNHAUS		JOHN KORNHAUS	2018-01-26
502	2015-11-01	JOHN KORNHAUS		JOHN KORNHAUS	2017-03-21

Plan Statistics for PETERSON PROPERTIES, INC. GROUP LIFE PLAN

401k plan membership statisitcs for PETERSON PROPERTIES, INC. GROUP LIFE PLAN

Measure Date Value
2016: PETERSON PROPERTIES, INC. GROUP LIFE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-11-01 232
Total number of active participants reported on line 7a of the Form 5500 2016-11-01 0
Total of all active and inactive participants 2016-11-01 0
Total participants 2016-11-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-11-01 0
2015: PETERSON PROPERTIES, INC. GROUP LIFE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-11-01 249
Total number of active participants reported on line 7a of the Form 5500 2015-11-01 232
Total of all active and inactive participants 2015-11-01 232
Total participants 2015-11-01 232

Measure	Date	Value
2016: PETERSON PROPERTIES, INC. GROUP LIFE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-11-01	232
Total number of active participants reported on line 7a of the Form 5500	2016-11-01	0
Total of all active and inactive participants	2016-11-01	0
Total participants	2016-11-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-11-01	0
2015: PETERSON PROPERTIES, INC. GROUP LIFE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-11-01	249
Total number of active participants reported on line 7a of the Form 5500	2015-11-01	232
Total of all active and inactive participants	2015-11-01	232
Total participants	2015-11-01	232

Form 5500 Responses for PETERSON PROPERTIES, INC. GROUP LIFE PLAN

2016: PETERSON PROPERTIES, INC. GROUP LIFE PLAN 2016 form 5500 responses
2016-11-01	Type of plan entity	Single employer plan
2016-11-01	Submission has been amended	No
2016-11-01	This submission is the final filing	Yes
2016-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-11-01	Plan is a collectively bargained plan	No
2016-11-01	Plan funding arrangement – Insurance	Yes
2016-11-01	Plan benefit arrangement – Insurance	Yes
2015: PETERSON PROPERTIES, INC. GROUP LIFE PLAN 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	No
2015-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-11-01	Plan is a collectively bargained plan	No
2015-11-01	Plan funding arrangement – Insurance	Yes
2015-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 136921

Policy instance

Insurance contract or identification number	GL 136921
Number of Individuals Covered	232
Insurance policy start date	2016-01-01
Insurance policy end date	2016-12-31
Total amount of commissions paid to insurance broker	USD $3,228
Total amount of fees paid to insurance company	USD $76
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
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 $32,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,228
Amount paid for insurance broker fees	76
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?	3
Insurance broker name	BUKATY COMPANIES, INC.

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Company Name:	PETERSON PROPERTIES, INC.
Employer identification number (EIN):	480919120
NAIC Classification:	531110
NAIC Description:	Lessors of Residential Buildings and Dwellings

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1963-01-02
Company Identification Number:	153326
Legal Registered Office Address:	9 EAST MAIN ST PO BOX 148 CORFU United States of America (USA) 14036