401k Plan data: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN plan

COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN
Plan identification number	502

COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: COFFEY COMMUNICATIONS INC.

Employer identification number (EIN): 910931222

NAIC Classification: 511190

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-01-01 KATHRYN ZAHL KATHRYN ZAHL 2016-07-27
502 2014-01-01 KATHRYN ZAHL ALAN COFFEY 2015-07-29
502 2013-01-01 KATHRYN ZAHL ALAN COFFEY 2014-07-24
502 2012-01-01 KATHRYN ZAHL ALAN COFFEY 2013-07-18
502 2011-01-01 KATHRYN ZAHL ALAN COFFEY 2012-07-24
502 2009-01-01 KATHRYN ZAHL ALAN COFFEY 2010-07-09

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2015-01-01	KATHRYN ZAHL	KATHRYN ZAHL	2016-07-27
502	2014-01-01	KATHRYN ZAHL	ALAN COFFEY	2015-07-29
502	2013-01-01	KATHRYN ZAHL	ALAN COFFEY	2014-07-24
502	2012-01-01	KATHRYN ZAHL	ALAN COFFEY	2013-07-18
502	2011-01-01	KATHRYN ZAHL	ALAN COFFEY	2012-07-24
502	2009-01-01	KATHRYN ZAHL	ALAN COFFEY	2010-07-09

Plan Statistics for COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN

Measure Date Value
2015: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 123
Total of all active and inactive participants 2015-01-01 123
2014: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 123
Total of all active and inactive participants 2014-01-01 123
2013: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 123
Number of retired or separated participants receiving benefits 2013-01-01 4
Total of all active and inactive participants 2013-01-01 127
2012: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 108
Number of retired or separated participants receiving benefits 2012-01-01 7
Total of all active and inactive participants 2012-01-01 115
2011: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 120
Number of retired or separated participants receiving benefits 2011-01-01 3
Total of all active and inactive participants 2011-01-01 123
2009: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 137
Number of retired or separated participants receiving benefits 2009-01-01 10
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 147
Total participants 2009-01-01 147

Measure	Date	Value
2015: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	123
Total of all active and inactive participants	2015-01-01	123
2014: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	123
Total of all active and inactive participants	2014-01-01	123
2013: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	123
Number of retired or separated participants receiving benefits	2013-01-01	4
Total of all active and inactive participants	2013-01-01	127
2012: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	108
Number of retired or separated participants receiving benefits	2012-01-01	7
Total of all active and inactive participants	2012-01-01	115
2011: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	120
Number of retired or separated participants receiving benefits	2011-01-01	3
Total of all active and inactive participants	2011-01-01	123
2009: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	137
Number of retired or separated participants receiving benefits	2009-01-01	10
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	147
Total participants	2009-01-01	147

Form 5500 Responses for COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN

2015: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT 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: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT 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: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT 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: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT 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: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: COFFEY COMMUNICATIONS, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1040113
Policy instance	2
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	1911
Policy instance	1
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1040113
Policy instance	2
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	1911
Policy instance	1
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	1911
Policy instance	1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number	50014277
Policy instance	2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number	30011651
Policy instance	3
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	1038873
Policy instance	4
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	1911
Policy instance	1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number	30011651
Policy instance	4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number	50014277
Policy instance	2
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	1038873
Policy instance	3
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number	889929
Policy instance	4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number	30011651
Policy instance	3
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	1038873
Policy instance	2
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	WBT000611
Policy instance	1
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	1911
Policy instance	5
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	WBT000611
Policy instance	5
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	1911
Policy instance	3
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number	889929
Policy instance	2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number	30011651
Policy instance	1
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number	60010847
Policy instance	4

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Company Name:	COFFEY COMMUNICATIONS INC.
Employer identification number (EIN):	910931222
NAIC Classification:	511190