401k Plan data: UNIPOWER LLC HEALTH BENEFITS PLAN plan

UNIPOWER LLC HEALTH BENEFITS PLAN 401k Plan overview

Plan Name	UNIPOWER LLC HEALTH BENEFITS PLAN
Plan identification number	501

UNIPOWER LLC HEALTH BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name: UNIPOWER LLC

Employer identification number (EIN): 270427503

NAIC Classification: 425110
NAIC Description: Business to Business Electronic Markets

Additional information about UNIPOWER LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3404943

More information about UNIPOWER LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIPOWER LLC HEALTH BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-06-01
501 2015-06-01

Plan Statistics for UNIPOWER LLC HEALTH BENEFITS PLAN

401k plan membership statisitcs for UNIPOWER LLC HEALTH BENEFITS PLAN

Measure Date Value
2016: UNIPOWER LLC HEALTH BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 167
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 55
Number of retired or separated participants receiving benefits 2016-06-01 4
Number of other retired or separated participants entitled to future benefits 2016-06-01 1
Total of all active and inactive participants 2016-06-01 60
2015: UNIPOWER LLC HEALTH BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 0
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 161
Number of retired or separated participants receiving benefits 2015-06-01 3
Number of other retired or separated participants entitled to future benefits 2015-06-01 3
Total of all active and inactive participants 2015-06-01 167

Measure	Date	Value
2016: UNIPOWER LLC HEALTH BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	167
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	55
Number of retired or separated participants receiving benefits	2016-06-01	4
Number of other retired or separated participants entitled to future benefits	2016-06-01	1
Total of all active and inactive participants	2016-06-01	60
2015: UNIPOWER LLC HEALTH BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	0
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	161
Number of retired or separated participants receiving benefits	2015-06-01	3
Number of other retired or separated participants entitled to future benefits	2015-06-01	3
Total of all active and inactive participants	2015-06-01	167

Form 5500 Responses for UNIPOWER LLC HEALTH BENEFITS PLAN

2016: UNIPOWER LLC HEALTH BENEFITS PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Submission has been amended	No
2016-06-01	This submission is the final filing	No
2016-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-06-01	Plan is a collectively bargained plan	No
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2015: UNIPOWER LLC HEALTH BENEFITS PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	First time form 5500 has been submitted	Yes
2015-06-01	Submission has been amended	No
2015-06-01	This submission is the final filing	No
2015-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-06-01	Plan is a collectively bargained plan	No
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0905657

Policy instance

Insurance contract or identification number	0905657
Number of Individuals Covered	218
Insurance policy start date	2015-08-01
Insurance policy end date	2016-05-30
Total amount of commissions paid to insurance broker	USD $3,835
Total amount of fees paid to insurance company	USD $64,025
Are there contracts with allocated funds for individual policies?	No
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	Yes
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
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 $1,255,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,835
Amount paid for insurance broker fees	61191
Additional information about fees paid to insurance broker	COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9910936

Policy instance

Insurance contract or identification number	9910936
Number of Individuals Covered	231
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-30
Total amount of commissions paid to insurance broker	USD $1,627
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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	Yes
Life Insurance Welfare Benefit	No
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 $14,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,627
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

126145

Policy instance

Insurance contract or identification number	126145
Number of Individuals Covered	161
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $8,109
Total amount of fees paid to insurance company	USD $622
Are there contracts with allocated funds for individual policies?	No
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $82,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,109
Amount paid for insurance broker fees	622
Additional information about fees paid to insurance broker	COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

126144

Policy instance

Insurance contract or identification number	126144
Number of Individuals Covered	72
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $6,480
Total amount of fees paid to insurance company	USD $324
Are there contracts with allocated funds for individual policies?	No
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
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 $40,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,480
Amount paid for insurance broker fees	324
Additional information about fees paid to insurance broker	COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	USI INS SERVICES LLC

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Company Name:	UNIPOWER LLC
Employer identification number (EIN):	270427503
NAIC Classification:	425110
NAIC Description:	Business to Business Electronic Markets

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3404943