401k Plan data: HDM HYRAULICS LLC GROUP HEALTH PLAN plan

HDM HYRAULICS LLC GROUP HEALTH PLAN 401k Plan overview

Plan Name	HDM HYRAULICS LLC GROUP HEALTH PLAN
Plan identification number	510

HDM HYRAULICS LLC GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

HDM HYDRAULICS has sponsored the creation of one or more 401k plans.

Company Name: HDM HYDRAULICS

Employer identification number (EIN): 810631854

NAIC Classification: 331500

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HDM HYRAULICS LLC GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2017-01-01 JUSTIN MAYFIELD
510 2016-01-01 JUSTIN MAYFIELD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
510	2017-01-01	JUSTIN MAYFIELD
510	2016-01-01	JUSTIN MAYFIELD

Plan Statistics for HDM HYRAULICS LLC GROUP HEALTH PLAN

401k plan membership statisitcs for HDM HYRAULICS LLC GROUP HEALTH PLAN

Measure Date Value
2017: HDM HYRAULICS LLC GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
2016: HDM HYRAULICS LLC GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 136
Total of all active and inactive participants 2016-01-01 136

Measure	Date	Value
2017: HDM HYRAULICS LLC GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
2016: HDM HYRAULICS LLC GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	136
Total of all active and inactive participants	2016-01-01	136

Form 5500 Responses for HDM HYRAULICS LLC GROUP HEALTH PLAN

2017: HDM HYRAULICS LLC GROUP HEALTH PLAN 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	Yes
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: HDM HYRAULICS LLC GROUP HEALTH PLAN 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

INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 )

Policy contract number

32990

Policy instance

Insurance contract or identification number	32990
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
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	Yes
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	LAWLEY BENEFITS GROUP, LLC

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Company Name:	HDM HYDRAULICS
Employer identification number (EIN):	810631854
NAIC Classification:	331500