401k Plan data: WINDOOR INCORPORATED MEDICAL PLAN plan

WINDOOR INCORPORATED MEDICAL PLAN 401k Plan overview

Plan Name	WINDOOR INCORPORATED MEDICAL PLAN
Plan identification number	502

WINDOOR INCORPORATED MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: WINDOOR, INC.

Employer identification number (EIN): 593689570

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WINDOOR INCORPORATED MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-12-01
502 2016-12-01
502 2015-12-01 DEBBIE LAPINSKA
502 2014-12-01 SHENNA BARNEY R. FRANK LUKENS 2016-06-02
502 2013-12-01 SHENNA BARNEY R. FRANK LUKENS, JR. 2015-06-08
502 2012-12-01 SHENNA BARNEY R. FRANK LUKENS 2014-05-21
502 2011-12-01 KAREN LUKENS R. FRANK LUKENS, JR. 2013-05-21
502 2010-12-01 KAREN LUKENS R. FRANK LUKENS, JR. 2012-05-08
502 2009-12-01 KAREN LUKENS R. FRANK LUKENS, JR. 2011-06-01

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2017-12-01
502	2016-12-01
502	2015-12-01	DEBBIE LAPINSKA
502	2014-12-01	SHENNA BARNEY	R. FRANK LUKENS	2016-06-02
502	2013-12-01	SHENNA BARNEY	R. FRANK LUKENS, JR.	2015-06-08
502	2012-12-01	SHENNA BARNEY	R. FRANK LUKENS	2014-05-21
502	2011-12-01	KAREN LUKENS	R. FRANK LUKENS, JR.	2013-05-21
502	2010-12-01	KAREN LUKENS	R. FRANK LUKENS, JR.	2012-05-08
502	2009-12-01	KAREN LUKENS	R. FRANK LUKENS, JR.	2011-06-01

Plan Statistics for WINDOOR INCORPORATED MEDICAL PLAN

401k plan membership statisitcs for WINDOOR INCORPORATED MEDICAL PLAN

Measure Date Value
2017: WINDOOR INCORPORATED MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-12-01 173
Total number of active participants reported on line 7a of the Form 5500 2017-12-01 0
Number of retired or separated participants receiving benefits 2017-12-01 0
Number of other retired or separated participants entitled to future benefits 2017-12-01 0
Total of all active and inactive participants 2017-12-01 0
2016: WINDOOR INCORPORATED MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-12-01 209
Total number of active participants reported on line 7a of the Form 5500 2016-12-01 171
Number of retired or separated participants receiving benefits 2016-12-01 2
Number of other retired or separated participants entitled to future benefits 2016-12-01 0
Total of all active and inactive participants 2016-12-01 173
2015: WINDOOR INCORPORATED MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-12-01 180
Total number of active participants reported on line 7a of the Form 5500 2015-12-01 208
Number of retired or separated participants receiving benefits 2015-12-01 1
Number of other retired or separated participants entitled to future benefits 2015-12-01 0
Total of all active and inactive participants 2015-12-01 209
2014: WINDOOR INCORPORATED MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-12-01 152
Total number of active participants reported on line 7a of the Form 5500 2014-12-01 183
Number of retired or separated participants receiving benefits 2014-12-01 2
Number of other retired or separated participants entitled to future benefits 2014-12-01 11
Total of all active and inactive participants 2014-12-01 196
2013: WINDOOR INCORPORATED MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-12-01 140
Total number of active participants reported on line 7a of the Form 5500 2013-12-01 151
Number of retired or separated participants receiving benefits 2013-12-01 0
Number of other retired or separated participants entitled to future benefits 2013-12-01 0
Total of all active and inactive participants 2013-12-01 151
2012: WINDOOR INCORPORATED MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-12-01 114
Total number of active participants reported on line 7a of the Form 5500 2012-12-01 140
Number of retired or separated participants receiving benefits 2012-12-01 1
Number of other retired or separated participants entitled to future benefits 2012-12-01 7
Total of all active and inactive participants 2012-12-01 148
2011: WINDOOR INCORPORATED MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-12-01 100
Total number of active participants reported on line 7a of the Form 5500 2011-12-01 112
Number of retired or separated participants receiving benefits 2011-12-01 2
Number of other retired or separated participants entitled to future benefits 2011-12-01 0
Total of all active and inactive participants 2011-12-01 114
2010: WINDOOR INCORPORATED MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-12-01 115
Total number of active participants reported on line 7a of the Form 5500 2010-12-01 100
Number of retired or separated participants receiving benefits 2010-12-01 4
Number of other retired or separated participants entitled to future benefits 2010-12-01 0
Total of all active and inactive participants 2010-12-01 104
2009: WINDOOR INCORPORATED MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-12-01 124
Total number of active participants reported on line 7a of the Form 5500 2009-12-01 112
Number of retired or separated participants receiving benefits 2009-12-01 3
Number of other retired or separated participants entitled to future benefits 2009-12-01 0
Total of all active and inactive participants 2009-12-01 115

Measure	Date	Value
2017: WINDOOR INCORPORATED MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-12-01	173
Total number of active participants reported on line 7a of the Form 5500	2017-12-01	0
Number of retired or separated participants receiving benefits	2017-12-01	0
Number of other retired or separated participants entitled to future benefits	2017-12-01	0
Total of all active and inactive participants	2017-12-01	0
2016: WINDOOR INCORPORATED MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-12-01	209
Total number of active participants reported on line 7a of the Form 5500	2016-12-01	171
Number of retired or separated participants receiving benefits	2016-12-01	2
Number of other retired or separated participants entitled to future benefits	2016-12-01	0
Total of all active and inactive participants	2016-12-01	173
2015: WINDOOR INCORPORATED MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-12-01	180
Total number of active participants reported on line 7a of the Form 5500	2015-12-01	208
Number of retired or separated participants receiving benefits	2015-12-01	1
Number of other retired or separated participants entitled to future benefits	2015-12-01	0
Total of all active and inactive participants	2015-12-01	209
2014: WINDOOR INCORPORATED MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-12-01	152
Total number of active participants reported on line 7a of the Form 5500	2014-12-01	183
Number of retired or separated participants receiving benefits	2014-12-01	2
Number of other retired or separated participants entitled to future benefits	2014-12-01	11
Total of all active and inactive participants	2014-12-01	196
2013: WINDOOR INCORPORATED MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-12-01	140
Total number of active participants reported on line 7a of the Form 5500	2013-12-01	151
Number of retired or separated participants receiving benefits	2013-12-01	0
Number of other retired or separated participants entitled to future benefits	2013-12-01	0
Total of all active and inactive participants	2013-12-01	151
2012: WINDOOR INCORPORATED MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-12-01	114
Total number of active participants reported on line 7a of the Form 5500	2012-12-01	140
Number of retired or separated participants receiving benefits	2012-12-01	1
Number of other retired or separated participants entitled to future benefits	2012-12-01	7
Total of all active and inactive participants	2012-12-01	148
2011: WINDOOR INCORPORATED MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-12-01	100
Total number of active participants reported on line 7a of the Form 5500	2011-12-01	112
Number of retired or separated participants receiving benefits	2011-12-01	2
Number of other retired or separated participants entitled to future benefits	2011-12-01	0
Total of all active and inactive participants	2011-12-01	114
2010: WINDOOR INCORPORATED MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-12-01	115
Total number of active participants reported on line 7a of the Form 5500	2010-12-01	100
Number of retired or separated participants receiving benefits	2010-12-01	4
Number of other retired or separated participants entitled to future benefits	2010-12-01	0
Total of all active and inactive participants	2010-12-01	104
2009: WINDOOR INCORPORATED MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-12-01	124
Total number of active participants reported on line 7a of the Form 5500	2009-12-01	112
Number of retired or separated participants receiving benefits	2009-12-01	3
Number of other retired or separated participants entitled to future benefits	2009-12-01	0
Total of all active and inactive participants	2009-12-01	115

Form 5500 Responses for WINDOOR INCORPORATED MEDICAL PLAN

2017: WINDOOR INCORPORATED MEDICAL PLAN 2017 form 5500 responses
2017-12-01	Type of plan entity	Single employer plan
2017-12-01	Submission has been amended	No
2017-12-01	This submission is the final filing	Yes
2017-12-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-12-01	Plan is a collectively bargained plan	No
2017-12-01	Plan funding arrangement – Insurance	Yes
2017-12-01	Plan benefit arrangement – Insurance	Yes
2016: WINDOOR INCORPORATED MEDICAL PLAN 2016 form 5500 responses
2016-12-01	Type of plan entity	Single employer plan
2016-12-01	Submission has been amended	No
2016-12-01	This submission is the final filing	No
2016-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-12-01	Plan is a collectively bargained plan	No
2016-12-01	Plan funding arrangement – Insurance	Yes
2016-12-01	Plan benefit arrangement – Insurance	Yes
2015: WINDOOR INCORPORATED MEDICAL PLAN 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	Submission has been amended	No
2015-12-01	This submission is the final filing	No
2015-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-12-01	Plan is a collectively bargained plan	No
2015-12-01	Plan funding arrangement – Insurance	Yes
2015-12-01	Plan benefit arrangement – Insurance	Yes
2014: WINDOOR INCORPORATED MEDICAL PLAN 2014 form 5500 responses
2014-12-01	Type of plan entity	Single employer plan
2014-12-01	Submission has been amended	No
2014-12-01	This submission is the final filing	No
2014-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-12-01	Plan is a collectively bargained plan	No
2014-12-01	Plan funding arrangement – Insurance	Yes
2014-12-01	Plan benefit arrangement – Insurance	Yes
2013: WINDOOR INCORPORATED MEDICAL PLAN 2013 form 5500 responses
2013-12-01	Type of plan entity	Single employer plan
2013-12-01	Submission has been amended	No
2013-12-01	This submission is the final filing	No
2013-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-12-01	Plan is a collectively bargained plan	No
2013-12-01	Plan funding arrangement – Insurance	Yes
2013-12-01	Plan benefit arrangement – Insurance	Yes
2012: WINDOOR INCORPORATED MEDICAL PLAN 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Submission has been amended	No
2012-12-01	This submission is the final filing	No
2012-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-12-01	Plan is a collectively bargained plan	No
2012-12-01	Plan funding arrangement – Insurance	Yes
2012-12-01	Plan benefit arrangement – Insurance	Yes
2011: WINDOOR INCORPORATED MEDICAL PLAN 2011 form 5500 responses
2011-12-01	Type of plan entity	Single employer plan
2011-12-01	Submission has been amended	No
2011-12-01	This submission is the final filing	No
2011-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-12-01	Plan is a collectively bargained plan	No
2011-12-01	Plan funding arrangement – Insurance	Yes
2011-12-01	Plan benefit arrangement – Insurance	Yes
2010: WINDOOR INCORPORATED MEDICAL PLAN 2010 form 5500 responses
2010-12-01	Type of plan entity	Single employer plan
2010-12-01	Submission has been amended	No
2010-12-01	This submission is the final filing	No
2010-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-12-01	Plan is a collectively bargained plan	No
2010-12-01	Plan funding arrangement – Insurance	Yes
2010-12-01	Plan benefit arrangement – Insurance	Yes
2009: WINDOOR INCORPORATED MEDICAL PLAN 2009 form 5500 responses
2009-12-01	Type of plan entity	Single employer plan
2009-12-01	Submission has been amended	No
2009-12-01	This submission is the final filing	No
2009-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-12-01	Plan is a collectively bargained plan	No
2009-12-01	Plan funding arrangement – Insurance	Yes
2009-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10036231001

Policy instance

Insurance contract or identification number	10036231001
Number of Individuals Covered	173
Insurance policy start date	2017-12-01
Insurance policy end date	2017-12-31
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	Yes
Life Insurance Welfare Benefit	No
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	WINDOOR, INC.
Employer identification number (EIN):	593689570
NAIC Classification:	332900