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| Plan Name | MEDICAL INSURANCE |
| Plan identification number | 510 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CONLEASCO INC. DBA BECKER FURNIT |
| Employer identification number (EIN): | 411309858 |
| NAIC Classification: | 442110 |
| NAIC Description: | Furniture Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 510 | 2014-01-01 | DEANNA ANDERSON | |||
| 510 | 2013-01-01 | DEANNA ANDERSON | |||
| 510 | 2012-01-01 | DEANNA ANDERSON |
| Measure | Date | Value |
|---|---|---|
| 2014: MEDICAL INSURANCE 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-01-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 0 |
| 2013: MEDICAL INSURANCE 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-01-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 116 |
| Total of all active and inactive participants | 2013-01-01 | 116 |
| Total participants | 2013-01-01 | 116 |
| 2012: MEDICAL INSURANCE 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-01-01 | 92 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 108 |
| Total of all active and inactive participants | 2012-01-01 | 108 |
| Total participants | 2012-01-01 | 108 |
| 2014: MEDICAL INSURANCE 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 | Yes |
| 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 benefit arrangement – Insurance | Yes |
| 2013: MEDICAL INSURANCE 2013 form 5500 responses | ||
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 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 benefit arrangement – Insurance | Yes |
| 2012: MEDICAL INSURANCE 2012 form 5500 responses | ||
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | First time form 5500 has been submitted | Yes |
| 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 |
| PREFERREDONE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11817 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | PCH10400 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| PREFERREDONE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11817 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | PCH10400 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| PREFERREDONE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11817 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | PCH10400 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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