401k Plan data: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN plan

HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 401k Plan overview

Plan Name	HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN
Plan identification number	503

HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

DRAKE INDUSTRIES, LLC has sponsored the creation of one or more 401k plans.

Company Name: DRAKE INDUSTRIES, LLC

Employer identification number (EIN): 621798003

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-01-01 DARIN DRAKE DARIN DRAKE 2016-07-19
503 2014-01-01 DARIN DRAKE DARIN DRAKE 2015-07-20
503 2013-01-01 DARIN DRAKE DARIN DRAKE 2014-07-17
503 2012-01-01 DARIN DRAKE DARIN DRAKE 2013-06-28
503 2011-01-01 DARIN DRAKE DARIN DRAKE 2012-10-03
503 2009-01-01 DARIN K. DRAKE
503 2009-01-01 DARIN K. DRAKE

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2015-01-01	DARIN DRAKE	DARIN DRAKE	2016-07-19
503	2014-01-01	DARIN DRAKE	DARIN DRAKE	2015-07-20
503	2013-01-01	DARIN DRAKE	DARIN DRAKE	2014-07-17
503	2012-01-01	DARIN DRAKE	DARIN DRAKE	2013-06-28
503	2011-01-01	DARIN DRAKE	DARIN DRAKE	2012-10-03
503	2009-01-01	DARIN K. DRAKE
503	2009-01-01	DARIN K. DRAKE

Plan Statistics for HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN

401k plan membership statisitcs for HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN

Measure Date Value
2015: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 263
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 225
Number of retired or separated participants receiving benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 228
2014: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 257
Number of retired or separated participants receiving benefits 2014-01-01 6
Total of all active and inactive participants 2014-01-01 263
2013: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 254
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 243
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 243
2012: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 241
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 254
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 254
2011: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 425
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 241
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 241
2009: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 342
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 346
Total of all active and inactive participants 2009-01-01 346

Measure	Date	Value
2015: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	263
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	225
Number of retired or separated participants receiving benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	228
2014: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	257
Number of retired or separated participants receiving benefits	2014-01-01	6
Total of all active and inactive participants	2014-01-01	263
2013: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	254
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	243
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	243
2012: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	241
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	254
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	254
2011: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	425
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	241
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	241
2009: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	342
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	346
Total of all active and inactive participants	2009-01-01	346

Form 5500 Responses for HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN

2015: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: HENDRICK MANUFACTURING COMPANY HEALTH INSURANCE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	DRAKE INDUSTRIES, LLC
Employer identification number (EIN):	621798003
NAIC Classification:	332900