401k Plan data: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN plan

VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 401k Plan overview

Plan Name	VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN
Plan identification number	541

VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

WELLS LAMONT CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: WELLS LAMONT CORPORATION

Employer identification number (EIN): 364264748

NAIC Classification: 315990
NAIC Description: Apparel Accessories and Other Apparel Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
541 2017-01-01 THERESA CHIP
541 2016-01-01 THERESA CHIP THERESA CHIP 2017-07-07
541 2014-01-01 THERESA CHIP THERESA CHIP 2015-07-15
541 2012-01-01 THERESA CHIP THERESA CHIP 2013-07-25
541 2011-01-01 THERESA CHIP THERESA CHIP 2012-07-24
541 2009-01-01 THERESA CHIP THERESA CHIP 2010-08-02

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
541	2017-01-01	THERESA CHIP
541	2016-01-01	THERESA CHIP	THERESA CHIP	2017-07-07
541	2014-01-01	THERESA CHIP	THERESA CHIP	2015-07-15
541	2012-01-01	THERESA CHIP	THERESA CHIP	2013-07-25
541	2011-01-01	THERESA CHIP	THERESA CHIP	2012-07-24
541	2009-01-01	THERESA CHIP	THERESA CHIP	2010-08-02

Plan Statistics for VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

401k plan membership statisitcs for VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

Measure Date Value
2017: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 40
Total of all active and inactive participants 2017-01-01 40
2016: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 37
Total of all active and inactive participants 2016-01-01 37
2014: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 36
Total of all active and inactive participants 2014-01-01 36
2012: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 33
Total of all active and inactive participants 2012-01-01 33
2011: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 35
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 38
Total of all active and inactive participants 2011-01-01 38
2009: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 43
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 33
Number of retired or separated participants receiving benefits 2009-01-01 0
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 33

Measure	Date	Value
2017: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	40
Total of all active and inactive participants	2017-01-01	40
2016: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	37
Total of all active and inactive participants	2016-01-01	37
2014: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	36
Total of all active and inactive participants	2014-01-01	36
2012: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	33
Total of all active and inactive participants	2012-01-01	33
2011: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	35
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	38
Total of all active and inactive participants	2011-01-01	38
2009: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	43
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	33
Number of retired or separated participants receiving benefits	2009-01-01	0
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	33

Financial Data on VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

Measure	Date	Value
2016 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$4,280
Expenses. Total of all expenses incurred	2016-12-31	$0
Value of fidelity bond covering the plan	2016-12-31	$2,000,000
Total contributions received or receivable from participants	2016-12-31	$4,280
Net income (gross income less expenses)	2016-12-31	$4,280
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$0
2015 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$4,220
Expenses. Total of all expenses incurred	2015-12-31	$0
Value of fidelity bond covering the plan	2015-12-31	$2,000,000
Total contributions received or receivable from participants	2015-12-31	$4,220
Net income (gross income less expenses)	2015-12-31	$4,220
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$0
2014 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$4,076
Expenses. Total of all expenses incurred	2014-12-31	$0
Value of fidelity bond covering the plan	2014-12-31	$2,000,000
Total contributions received or receivable from participants	2014-12-31	$4,076
Net income (gross income less expenses)	2014-12-31	$4,076
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$0
2013 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$4,076
Expenses. Total of all expenses incurred	2013-12-31	$0
Total plan assets at beginning of year	2013-12-31	$0
Value of fidelity bond covering the plan	2013-12-31	$2,000,000
Total contributions received or receivable from participants	2013-12-31	$4,076
Net income (gross income less expenses)	2013-12-31	$4,076
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$0
2012 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$4,018
Expenses. Total of all expenses incurred	2012-12-31	$0
Total plan assets at beginning of year	2012-12-31	$0
Value of fidelity bond covering the plan	2012-12-31	$2,000,000
Total contributions received or receivable from participants	2012-12-31	$4,018
Net income (gross income less expenses)	2012-12-31	$4,018
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$0
2011 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$4,481
Expenses. Total of all expenses incurred	2011-12-31	$0
Total plan assets at beginning of year	2011-12-31	$0
Value of fidelity bond covering the plan	2011-12-31	$2,000,000
Total contributions received or receivable from participants	2011-12-31	$4,481
Net income (gross income less expenses)	2011-12-31	$4,481
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$0
2010 : VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$4,141
Expenses. Total of all expenses incurred	2010-12-31	$0
Value of fidelity bond covering the plan	2010-12-31	$2,000,000
Total contributions received or receivable from participants	2010-12-31	$4,141
Net income (gross income less expenses)	2010-12-31	$4,141
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0

Form 5500 Responses for VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN

2017: VOLUNTARY ACCIDENTAL DEATH & DISABILITY 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	No
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: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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
2012: VOLUNTARY ACCIDENTAL DEATH & DISABILITY 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 benefit arrangement – Insurance	Yes
2011: VOLUNTARY ACCIDENTAL DEATH & DISABILITY 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: VOLUNTARY ACCIDENTAL DEATH & DISABILITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 )
Policy contract number	83025909
Policy instance	1

Potentially related plans

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Company Name:	WELLS LAMONT CORPORATION
Employer identification number (EIN):	364264748
NAIC Classification:	315990
NAIC Description:	Apparel Accessories and Other Apparel Manufacturing