401k Plan data: ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS plan

ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS 401k Plan overview

Plan Name	ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS
Plan identification number	501

ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

ALBERT & MACKENZIE, A PROFESSIONAL LAW CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: ALBERT & MACKENZIE, A PROFESSIONAL LAW CORPORATION

Employer identification number (EIN): 522342645

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 ADRIANA WENDLAND
501 2016-01-01 ADRIANA WENDLAND

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2017-01-01	ADRIANA WENDLAND
501	2016-01-01	ADRIANA WENDLAND

Plan Statistics for ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS

401k plan membership statisitcs for ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS

Measure Date Value
2017: ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS 2017 401k membership
Total participants, beginning-of-year 2017-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 108
Total of all active and inactive participants 2017-01-01 108
Total participants 2017-01-01 108
2016: ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS 2016 401k membership
Total participants, beginning-of-year 2016-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 105
Total of all active and inactive participants 2016-01-01 105
Total participants 2016-01-01 105

Measure	Date	Value
2017: ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS 2017 401k membership
Total participants, beginning-of-year	2017-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	108
Total of all active and inactive participants	2017-01-01	108
Total participants	2017-01-01	108
2016: ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS 2016 401k membership
Total participants, beginning-of-year	2016-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	105
Total of all active and inactive participants	2016-01-01	105
Total participants	2016-01-01	105

Form 5500 Responses for ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS

2017: ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: ALBERT AND MACKENZIE LIFE AND DISABILITY BENEFITS 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

421481

Policy instance

Insurance contract or identification number	421481
Number of Individuals Covered	108
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,585
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
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 $65,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,784
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FONTAINE MCLAREN INC

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Company Name:	ALBERT & MACKENZIE, A PROFESSIONAL LAW CORPORATION
Employer identification number (EIN):	522342645
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers