401k Plan data: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN plan

TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 401k Plan overview

Plan Name	TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN
Plan identification number	506

TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN Benefits

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

401k Sponsoring company profile

TIFFIN MOTOR HOMES, INC. has sponsored the creation of one or more 401k plans.

Company Name: TIFFIN MOTOR HOMES, INC.

Employer identification number (EIN): 630636444

NAIC Classification: 336100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2011-04-01 TIMOTHY TIFFIN
506 2010-04-01 TIMOTHY TIFFIN
506 2009-04-01 TIMOTHY TIFFIN

Plan id#	Filing Submission Date	Name of Administrator
506	2011-04-01	TIMOTHY TIFFIN
506	2010-04-01	TIMOTHY TIFFIN
506	2009-04-01	TIMOTHY TIFFIN

Plan Statistics for TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN

401k plan membership statisitcs for TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN

Measure Date Value
2011: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2011 401k membership
Total participants, beginning-of-year 2011-04-01 1,236
Total number of active participants reported on line 7a of the Form 5500 2011-04-01 0
Total of all active and inactive participants 2011-04-01 0
2010: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2010 401k membership
Total participants, beginning-of-year 2010-04-01 980
Total number of active participants reported on line 7a of the Form 5500 2010-04-01 1,236
Total of all active and inactive participants 2010-04-01 1,236
2009: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2009 401k membership
Total participants, beginning-of-year 2009-04-01 980
Total number of active participants reported on line 7a of the Form 5500 2009-04-01 980
Total of all active and inactive participants 2009-04-01 980

Measure	Date	Value
2011: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2011 401k membership
Total participants, beginning-of-year	2011-04-01	1,236
Total number of active participants reported on line 7a of the Form 5500	2011-04-01	0
Total of all active and inactive participants	2011-04-01	0
2010: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2010 401k membership
Total participants, beginning-of-year	2010-04-01	980
Total number of active participants reported on line 7a of the Form 5500	2010-04-01	1,236
Total of all active and inactive participants	2010-04-01	1,236
2009: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2009 401k membership
Total participants, beginning-of-year	2009-04-01	980
Total number of active participants reported on line 7a of the Form 5500	2009-04-01	980
Total of all active and inactive participants	2009-04-01	980

Form 5500 Responses for TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN

2011: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2011 form 5500 responses
2011-04-01	Type of plan entity	Single employer plan
2011-04-01	Submission has been amended	No
2011-04-01	This submission is the final filing	Yes
2011-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-04-01	Plan is a collectively bargained plan	No
2011-04-01	Plan funding arrangement – Insurance	Yes
2011-04-01	Plan benefit arrangement – Insurance	Yes
2010: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2010 form 5500 responses
2010-04-01	Type of plan entity	Single employer plan
2010-04-01	Submission has been amended	No
2010-04-01	This submission is the final filing	No
2010-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-04-01	Plan is a collectively bargained plan	No
2010-04-01	Plan funding arrangement – Insurance	Yes
2010-04-01	Plan benefit arrangement – Insurance	Yes
2009: TIFFIN MOTOR HOMES, INC. INDEMNITY AND AD&D PLAN 2009 form 5500 responses
2009-04-01	Type of plan entity	Single employer plan
2009-04-01	First time form 5500 has been submitted	Yes
2009-04-01	Submission has been amended	No
2009-04-01	This submission is the final filing	No
2009-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-04-01	Plan is a collectively bargained plan	No
2009-04-01	Plan funding arrangement – Insurance	Yes
2009-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 964475

Policy instance

Insurance contract or identification number	OK 964475
Number of Individuals Covered	1236
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $2,625
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
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $16,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,625
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ILLINOIS, INC.

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 964475

Policy instance

Insurance contract or identification number	OK 964475
Number of Individuals Covered	1126
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $2,507
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
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $15,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,507
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ILLINOIS, INC.

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 964475

Policy instance

Insurance contract or identification number	OK 964475
Number of Individuals Covered	980
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $1,791
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
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $11,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,791
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ILLINOIS, INC.

Potentially related plans

TIFFIN MOTOR HOMES, INC. ACCIDENT PLAN [EIN = 060636444]

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Company Name:	TIFFIN MOTOR HOMES, INC.
Employer identification number (EIN):	630636444
NAIC Classification:	336100