401k Plan data: CLARY HOOD, INC. GROUP INSURANCE PLAN plan

CLARY HOOD, INC. GROUP INSURANCE PLAN 401k Plan overview

Plan Name	CLARY HOOD, INC. GROUP INSURANCE PLAN
Plan identification number	501

CLARY HOOD, INC. GROUP INSURANCE PLAN Benefits

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

401k Sponsoring company profile

CLARY HOOD, INC. has sponsored the creation of one or more 401k plans.

Company Name: CLARY HOOD, INC.

Employer identification number (EIN): 570702841

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLARY HOOD, INC. GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-08-01 SHEILA ALEXANDER 2020-01-30
501 2017-08-01
501 2016-08-01

Plan Statistics for CLARY HOOD, INC. GROUP INSURANCE PLAN

401k plan membership statisitcs for CLARY HOOD, INC. GROUP INSURANCE PLAN

Measure Date Value
2018: CLARY HOOD, INC. GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-08-01 138
Total number of active participants reported on line 7a of the Form 5500 2018-08-01 110
Number of retired or separated participants receiving benefits 2018-08-01 1
Number of other retired or separated participants entitled to future benefits 2018-08-01 0
Total of all active and inactive participants 2018-08-01 111
Number of employers contributing to the scheme 2018-08-01 0
2017: CLARY HOOD, INC. GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-08-01 109
Total number of active participants reported on line 7a of the Form 5500 2017-08-01 138
Number of retired or separated participants receiving benefits 2017-08-01 0
Number of other retired or separated participants entitled to future benefits 2017-08-01 0
Total of all active and inactive participants 2017-08-01 138
2016: CLARY HOOD, INC. GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-08-01 109
Total number of active participants reported on line 7a of the Form 5500 2016-08-01 109
Number of retired or separated participants receiving benefits 2016-08-01 0
Number of other retired or separated participants entitled to future benefits 2016-08-01 0
Total of all active and inactive participants 2016-08-01 109

Measure	Date	Value
2018: CLARY HOOD, INC. GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-08-01	138
Total number of active participants reported on line 7a of the Form 5500	2018-08-01	110
Number of retired or separated participants receiving benefits	2018-08-01	1
Number of other retired or separated participants entitled to future benefits	2018-08-01	0
Total of all active and inactive participants	2018-08-01	111
Number of employers contributing to the scheme	2018-08-01	0
2017: CLARY HOOD, INC. GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-08-01	109
Total number of active participants reported on line 7a of the Form 5500	2017-08-01	138
Number of retired or separated participants receiving benefits	2017-08-01	0
Number of other retired or separated participants entitled to future benefits	2017-08-01	0
Total of all active and inactive participants	2017-08-01	138
2016: CLARY HOOD, INC. GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-08-01	109
Total number of active participants reported on line 7a of the Form 5500	2016-08-01	109
Number of retired or separated participants receiving benefits	2016-08-01	0
Number of other retired or separated participants entitled to future benefits	2016-08-01	0
Total of all active and inactive participants	2016-08-01	109

Form 5500 Responses for CLARY HOOD, INC. GROUP INSURANCE PLAN

2018: CLARY HOOD, INC. GROUP INSURANCE PLAN 2018 form 5500 responses
2018-08-01	Type of plan entity	Single employer plan
2018-08-01	Plan funding arrangement – Insurance	Yes
2018-08-01	Plan benefit arrangement – Insurance	Yes
2017: CLARY HOOD, INC. GROUP INSURANCE PLAN 2017 form 5500 responses
2017-08-01	Type of plan entity	Single employer plan
2017-08-01	Plan funding arrangement – Insurance	Yes
2017-08-01	Plan benefit arrangement – Insurance	Yes
2016: CLARY HOOD, INC. GROUP INSURANCE PLAN 2016 form 5500 responses
2016-08-01	Type of plan entity	Single employer plan
2016-08-01	First time form 5500 has been submitted	Yes
2016-08-01	Submission has been amended	No
2016-08-01	This submission is the final filing	No
2016-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-08-01	Plan is a collectively bargained plan	No
2016-08-01	Plan funding arrangement – Insurance	Yes
2016-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

66-17490-00

Policy instance

Insurance contract or identification number	66-17490-00
Number of Individuals Covered	110
Insurance policy start date	2018-08-01
Insurance policy end date	2019-07-31
Total amount of commissions paid to insurance broker	USD $39,225
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,225
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

05-80104-00

Policy instance

Insurance contract or identification number	05-80104-00
Number of Individuals Covered	138
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CLARY HOOD, INC.
Employer identification number (EIN):	570702841
NAIC Classification:	238900

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2018-08-01	SHEILA ALEXANDER	2020-01-30
501	2017-08-01
501	2016-08-01