401k Plan data: ZURICH AMERICAN LIFE INSURANCE COMPANY plan

ZURICH AMERICAN LIFE INSURANCE COMPANY 401k Plan overview

Plan Name	ZURICH AMERICAN LIFE INSURANCE COMPANY
Plan identification number	502

ZURICH AMERICAN LIFE INSURANCE COMPANY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

WESTERN PNEUMATICS LLC has sponsored the creation of one or more 401k plans.

Company Name: WESTERN PNEUMATICS LLC

Employer identification number (EIN): 930885198

NAIC Classification: 333900

Additional information about WESTERN PNEUMATICS LLC

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1985-04-01

Company Identification Number: 20831210

Legal Registered Office Address: 110 N SENECA ROAD

EUGENE
United States of America (USA)
97402

More information about WESTERN PNEUMATICS LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ZURICH AMERICAN LIFE INSURANCE COMPANY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-09-01 DARLA PALAHNIUK DARLA PALAHNIUK 2018-10-04
502 2016-09-01 DARLA PALAHNIUK 2018-10-04
502 2015-09-01 DARLA PALAHNIUK DARLA PALAHNIUK 2017-05-22
502 2014-09-01 DARLA PALAHNIUK DARLA PALAHNIUK 2017-05-22
502 2013-09-01 DARLA PALAHNIUK DARLA PALAHNIUK 2017-05-22
502 2012-09-01 DARLA PALAHNIUK DARLA PALAHNIUK 2017-05-22

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2017-09-01	DARLA PALAHNIUK	DARLA PALAHNIUK	2018-10-04
502	2016-09-01		DARLA PALAHNIUK	2018-10-04
502	2015-09-01	DARLA PALAHNIUK	DARLA PALAHNIUK	2017-05-22
502	2014-09-01	DARLA PALAHNIUK	DARLA PALAHNIUK	2017-05-22
502	2013-09-01	DARLA PALAHNIUK	DARLA PALAHNIUK	2017-05-22
502	2012-09-01	DARLA PALAHNIUK	DARLA PALAHNIUK	2017-05-22

Plan Statistics for ZURICH AMERICAN LIFE INSURANCE COMPANY

401k plan membership statisitcs for ZURICH AMERICAN LIFE INSURANCE COMPANY

Measure Date Value
2017: ZURICH AMERICAN LIFE INSURANCE COMPANY 2017 401k membership
Total participants, beginning-of-year 2017-09-01 147
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 140
Total of all active and inactive participants 2017-09-01 140
Total participants 2017-09-01 140
2016: ZURICH AMERICAN LIFE INSURANCE COMPANY 2016 401k membership
Total participants, beginning-of-year 2016-09-01 143
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 146
Total of all active and inactive participants 2016-09-01 146
Total participants 2016-09-01 146
2015: ZURICH AMERICAN LIFE INSURANCE COMPANY 2015 401k membership
Total participants, beginning-of-year 2015-09-01 150
Total of all active and inactive participants 2015-09-01 0
Total participants 2015-09-01 0
2014: ZURICH AMERICAN LIFE INSURANCE COMPANY 2014 401k membership
Total participants, beginning-of-year 2014-09-01 151
Total of all active and inactive participants 2014-09-01 0
Total participants 2014-09-01 0
2013: ZURICH AMERICAN LIFE INSURANCE COMPANY 2013 401k membership
Total participants, beginning-of-year 2013-09-01 159
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 159
Total of all active and inactive participants 2013-09-01 159
Total participants 2013-09-01 159
2012: ZURICH AMERICAN LIFE INSURANCE COMPANY 2012 401k membership
Total participants, beginning-of-year 2012-09-01 144
Total of all active and inactive participants 2012-09-01 0
Total participants 2012-09-01 0

Measure	Date	Value
2017: ZURICH AMERICAN LIFE INSURANCE COMPANY 2017 401k membership
Total participants, beginning-of-year	2017-09-01	147
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	140
Total of all active and inactive participants	2017-09-01	140
Total participants	2017-09-01	140
2016: ZURICH AMERICAN LIFE INSURANCE COMPANY 2016 401k membership
Total participants, beginning-of-year	2016-09-01	143
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	146
Total of all active and inactive participants	2016-09-01	146
Total participants	2016-09-01	146
2015: ZURICH AMERICAN LIFE INSURANCE COMPANY 2015 401k membership
Total participants, beginning-of-year	2015-09-01	150
Total of all active and inactive participants	2015-09-01	0
Total participants	2015-09-01	0
2014: ZURICH AMERICAN LIFE INSURANCE COMPANY 2014 401k membership
Total participants, beginning-of-year	2014-09-01	151
Total of all active and inactive participants	2014-09-01	0
Total participants	2014-09-01	0
2013: ZURICH AMERICAN LIFE INSURANCE COMPANY 2013 401k membership
Total participants, beginning-of-year	2013-09-01	159
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	159
Total of all active and inactive participants	2013-09-01	159
Total participants	2013-09-01	159
2012: ZURICH AMERICAN LIFE INSURANCE COMPANY 2012 401k membership
Total participants, beginning-of-year	2012-09-01	144
Total of all active and inactive participants	2012-09-01	0
Total participants	2012-09-01	0

Form 5500 Responses for ZURICH AMERICAN LIFE INSURANCE COMPANY

2017: ZURICH AMERICAN LIFE INSURANCE COMPANY 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	First time form 5500 has been submitted	Yes
2017-09-01	Submission has been amended	No
2017-09-01	This submission is the final filing	No
2017-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-09-01	Plan is a collectively bargained plan	No
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: ZURICH AMERICAN LIFE INSURANCE COMPANY 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	First time form 5500 has been submitted	Yes
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: ZURICH AMERICAN LIFE INSURANCE COMPANY 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	First time form 5500 has been submitted	Yes
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: ZURICH AMERICAN LIFE INSURANCE COMPANY 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	First time form 5500 has been submitted	Yes
2014-09-01	Submission has been amended	No
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: ZURICH AMERICAN LIFE INSURANCE COMPANY 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	First time form 5500 has been submitted	Yes
2013-09-01	Submission has been amended	No
2013-09-01	This submission is the final filing	No
2013-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-09-01	Plan is a collectively bargained plan	No
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2012: ZURICH AMERICAN LIFE INSURANCE COMPANY 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	First time form 5500 has been submitted	Yes
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90557 )

Policy contract number

802423

Policy instance

Insurance contract or identification number	802423
Number of Individuals Covered	140
Insurance policy start date	2017-09-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $382
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $382
Insurance broker organization code?	3
Insurance broker name	KRAFT LAKE INSURANCE AGENCY

Potentially related plans

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Company Name:	WESTERN PNEUMATICS LLC
Employer identification number (EIN):	930885198
NAIC Classification:	333900

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1985-04-01
Company Identification Number:	20831210
Legal Registered Office Address:	110 N SENECA ROAD EUGENE United States of America (USA) 97402