401k Plan data: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN plan

DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 401k Plan overview

Plan Name	DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN
Plan identification number	501

DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

DONNELLY COMMUNICATIONS INC. has sponsored the creation of one or more 401k plans.

Company Name: DONNELLY COMMUNICATIONS INC.

Employer identification number (EIN): 630811791

NAIC Classification: 561420

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-06-01 PAMELA CARTER
501 2014-06-01 EVELYN JACKSON
501 2012-06-01 VIRGINIA CORSE VIRGINIA CORSE 2014-03-12

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-06-01	PAMELA CARTER
501	2014-06-01	EVELYN JACKSON
501	2012-06-01	VIRGINIA CORSE	VIRGINIA CORSE	2014-03-12

Plan Statistics for DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN

401k plan membership statisitcs for DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN

Measure Date Value
2016: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 120
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 122
Number of retired or separated participants receiving benefits 2016-06-01 0
Number of other retired or separated participants entitled to future benefits 2016-06-01 0
Total of all active and inactive participants 2016-06-01 122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-06-01 0
Total participants 2016-06-01 122
Number of participants with account balances 2016-06-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-06-01 0
Number of employers contributing to the scheme 2016-06-01 0
2014: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 108
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 191
Number of retired or separated participants receiving benefits 2014-06-01 0
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-06-01 0
Total participants 2014-06-01 191
Number of participants with account balances 2014-06-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-06-01 0
2012: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 58
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 108
Number of retired or separated participants receiving benefits 2012-06-01 0
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-06-01 0
Total participants 2012-06-01 108
Number of participants with account balances 2012-06-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-06-01 0

Measure	Date	Value
2016: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	120
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	122
Number of retired or separated participants receiving benefits	2016-06-01	0
Number of other retired or separated participants entitled to future benefits	2016-06-01	0
Total of all active and inactive participants	2016-06-01	122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-06-01	0
Total participants	2016-06-01	122
Number of participants with account balances	2016-06-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-06-01	0
Number of employers contributing to the scheme	2016-06-01	0
2014: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	108
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	191
Number of retired or separated participants receiving benefits	2014-06-01	0
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-06-01	0
Total participants	2014-06-01	191
Number of participants with account balances	2014-06-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-06-01	0
2012: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	58
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	108
Number of retired or separated participants receiving benefits	2012-06-01	0
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-06-01	0
Total participants	2012-06-01	108
Number of participants with account balances	2012-06-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-06-01	0

Form 5500 Responses for DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN

2016: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	First time form 5500 has been submitted	Yes
2016-06-01	Submission has been amended	No
2016-06-01	This submission is the final filing	No
2016-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-06-01	Plan is a collectively bargained plan	No
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2014: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	First time form 5500 has been submitted	Yes
2014-06-01	Submission has been amended	No
2014-06-01	This submission is the final filing	No
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2012: DONNELLY COMMUNICATIONS, INC. MEDICAL PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	First time form 5500 has been submitted	Yes
2012-06-01	Submission has been amended	No
2012-06-01	This submission is the final filing	No
2012-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-06-01	Plan is a collectively bargained plan	No
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	DONNELLY COMMUNICATIONS INC.
Employer identification number (EIN):	630811791
NAIC Classification:	561420