401k Plan data: BS&B SAFETY SYSTEMS

BS&B SAFETY SYSTEMS - DENTAL 401k Plan overview

Plan Name	BS&B SAFETY SYSTEMS - DENTAL
Plan identification number	513

BS&B SAFETY SYSTEMS - DENTAL Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

BS&B SAFETY SYSTEMS, LLC has sponsored the creation of one or more 401k plans.

Company Name: BS&B SAFETY SYSTEMS, LLC

Employer identification number (EIN): 730785967

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BS&B SAFETY SYSTEMS - DENTAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
513 2013-09-01 CHARLES HART CHARLES HART 2015-01-13
513 2013-09-01
513 2012-09-01 CHARLES HART ARTHUR HUSE 2013-11-11
513 2011-09-01 CHARLES HART ARTHUR HUSE 2012-12-28
513 2010-09-01 CHARLES HART ARTHUR HUSE 2012-06-13
513 2009-09-01 CHARLES HART ARTHUR HUSE 2011-06-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
513	2013-09-01	CHARLES HART	CHARLES HART	2015-01-13
513	2013-09-01
513	2012-09-01	CHARLES HART	ARTHUR HUSE	2013-11-11
513	2011-09-01	CHARLES HART	ARTHUR HUSE	2012-12-28
513	2010-09-01	CHARLES HART	ARTHUR HUSE	2012-06-13
513	2009-09-01	CHARLES HART	ARTHUR HUSE	2011-06-14

Plan Statistics for BS&B SAFETY SYSTEMS - DENTAL

401k plan membership statisitcs for BS&B SAFETY SYSTEMS - DENTAL

Measure Date Value
2013: BS&B SAFETY SYSTEMS - DENTAL 2013 401k membership
Total participants, beginning-of-year 2013-09-01 137
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 137
Number of retired or separated participants receiving benefits 2013-09-01 0
Number of other retired or separated participants entitled to future benefits 2013-09-01 0
Total of all active and inactive participants 2013-09-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-09-01 0
Total participants 2013-09-01 137
Number of participants with account balances 2013-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-09-01 0
2012: BS&B SAFETY SYSTEMS - DENTAL 2012 401k membership
Total participants, beginning-of-year 2012-09-01 135
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 135
Number of retired or separated participants receiving benefits 2012-09-01 0
Number of other retired or separated participants entitled to future benefits 2012-09-01 0
Total of all active and inactive participants 2012-09-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-09-01 0
Total participants 2012-09-01 135
Number of participants with account balances 2012-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-09-01 0
2011: BS&B SAFETY SYSTEMS - DENTAL 2011 401k membership
Total participants, beginning-of-year 2011-09-01 134
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 134
Number of retired or separated participants receiving benefits 2011-09-01 0
Number of other retired or separated participants entitled to future benefits 2011-09-01 0
Total of all active and inactive participants 2011-09-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-09-01 0
Total participants 2011-09-01 134
Number of participants with account balances 2011-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-09-01 0
2010: BS&B SAFETY SYSTEMS - DENTAL 2010 401k membership
Total participants, beginning-of-year 2010-09-01 119
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 119
Number of retired or separated participants receiving benefits 2010-09-01 0
Number of other retired or separated participants entitled to future benefits 2010-09-01 0
Total of all active and inactive participants 2010-09-01 119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-09-01 0
Total participants 2010-09-01 119
Number of participants with account balances 2010-09-01 0
2009: BS&B SAFETY SYSTEMS - DENTAL 2009 401k membership
Total participants, beginning-of-year 2009-09-01 113
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 113
Number of retired or separated participants receiving benefits 2009-09-01 0
Total of all active and inactive participants 2009-09-01 113
Total participants 2009-09-01 113

Measure	Date	Value
2013: BS&B SAFETY SYSTEMS - DENTAL 2013 401k membership
Total participants, beginning-of-year	2013-09-01	137
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	137
Number of retired or separated participants receiving benefits	2013-09-01	0
Number of other retired or separated participants entitled to future benefits	2013-09-01	0
Total of all active and inactive participants	2013-09-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-09-01	0
Total participants	2013-09-01	137
Number of participants with account balances	2013-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-09-01	0
2012: BS&B SAFETY SYSTEMS - DENTAL 2012 401k membership
Total participants, beginning-of-year	2012-09-01	135
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	135
Number of retired or separated participants receiving benefits	2012-09-01	0
Number of other retired or separated participants entitled to future benefits	2012-09-01	0
Total of all active and inactive participants	2012-09-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-09-01	0
Total participants	2012-09-01	135
Number of participants with account balances	2012-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-09-01	0
2011: BS&B SAFETY SYSTEMS - DENTAL 2011 401k membership
Total participants, beginning-of-year	2011-09-01	134
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	134
Number of retired or separated participants receiving benefits	2011-09-01	0
Number of other retired or separated participants entitled to future benefits	2011-09-01	0
Total of all active and inactive participants	2011-09-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-09-01	0
Total participants	2011-09-01	134
Number of participants with account balances	2011-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-09-01	0
2010: BS&B SAFETY SYSTEMS - DENTAL 2010 401k membership
Total participants, beginning-of-year	2010-09-01	119
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	119
Number of retired or separated participants receiving benefits	2010-09-01	0
Number of other retired or separated participants entitled to future benefits	2010-09-01	0
Total of all active and inactive participants	2010-09-01	119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-09-01	0
Total participants	2010-09-01	119
Number of participants with account balances	2010-09-01	0
2009: BS&B SAFETY SYSTEMS - DENTAL 2009 401k membership
Total participants, beginning-of-year	2009-09-01	113
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	113
Number of retired or separated participants receiving benefits	2009-09-01	0
Total of all active and inactive participants	2009-09-01	113
Total participants	2009-09-01	113

Form 5500 Responses for BS&B SAFETY SYSTEMS - DENTAL

2013: BS&B SAFETY SYSTEMS - DENTAL 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Submission has been amended	No
2013-09-01	This submission is the final filing	No
2013-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-09-01	Plan is a collectively bargained plan	No
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2012: BS&B SAFETY SYSTEMS - DENTAL 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: BS&B SAFETY SYSTEMS - DENTAL 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2010: BS&B SAFETY SYSTEMS - DENTAL 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	Submission has been amended	No
2010-09-01	This submission is the final filing	No
2010-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-09-01	Plan is a collectively bargained plan	No
2010-09-01	Plan funding arrangement – Insurance	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2009: BS&B SAFETY SYSTEMS - DENTAL 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Submission has been amended	No
2009-09-01	This submission is the final filing	No
2009-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-09-01	Plan is a collectively bargained plan	No
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00001D020391

Policy instance

Insurance contract or identification number	00001D020391
Number of Individuals Covered	137
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $3,308
Total amount of fees paid to insurance company	USD $1,944
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	Yes
Vision Insurance Welfare Benefit	No
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 $97,232
Commission paid to Insurance Broker	USD $3,308
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

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Company Name:	BS&B SAFETY SYSTEMS, LLC
Employer identification number (EIN):	730785967
NAIC Classification:	332900