401k Plan data: FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN plan

FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN 401k Plan overview

Plan Name	FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN
Plan identification number	501

FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Vision Temporary disability (accident and sickness)

401k Sponsoring company profile

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

Company Name: FLATOUT, INC.

Employer identification number (EIN): 271430026

NAIC Classification: 311800
NAIC Description: Bakeries and Tortilla Manufacturing

Additional information about FLATOUT, INC.

Jurisdiction of Incorporation: Colorado Department of State

Incorporation Date: 2016-10-15

Company Identification Number: 20161695637

Legal Registered Office Address: 528 Zircon Way

Superior
United States of America (USA)
80027

More information about FLATOUT, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-06-01 RICHARD GENTIL RICHARD GENTIL 2016-02-22
501 2013-06-01 RICHARD GENTIL RICHARD GENTIL 2016-02-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2014-06-01	RICHARD GENTIL		RICHARD GENTIL	2016-02-22
501	2013-06-01	RICHARD GENTIL		RICHARD GENTIL	2016-02-17

Plan Statistics for FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN

401k plan membership statisitcs for FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN

Measure Date Value
2014: FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 144
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 0
Total of all active and inactive participants 2014-06-01 0
Total participants 2014-06-01 0
2013: FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 121
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 143
Number of retired or separated participants receiving benefits 2013-06-01 1
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-06-01 0
Total participants 2013-06-01 144

Measure	Date	Value
2014: FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	144
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	0
Total of all active and inactive participants	2014-06-01	0
Total participants	2014-06-01	0
2013: FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	121
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	143
Number of retired or separated participants receiving benefits	2013-06-01	1
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-06-01	0
Total participants	2013-06-01	144

Form 5500 Responses for FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN

2014: FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	No
2014-06-01	This submission is the final filing	Yes
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: FLATOUT INC DENTAL AND VISION AND SHORT TERM DISABILITY PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	First time form 5500 has been submitted	Yes
2013-06-01	Submission has been amended	Yes
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EMPLOYEE BENEFIT CONCEPTS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

GR3462

Policy instance

Insurance contract or identification number	GR3462
Number of Individuals Covered	91
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of fees paid to insurance company	USD $5,960
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5960
Additional information about fees paid to insurance broker	CONSULTING FEES
Insurance broker name	STEVEN J. SWEENEY

EMPLOYEE BENEFIT CONCEPTS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

3462

Policy instance

Insurance contract or identification number	3462
Number of Individuals Covered	114
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of fees paid to insurance company	USD $4,584
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4584
Additional information about fees paid to insurance broker	CONSULTANT FEE
Insurance broker organization code?	3
Insurance broker name	STEVEN J SWEENEY

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Company Name:	FLATOUT, INC.
Employer identification number (EIN):	271430026
NAIC Classification:	311800
NAIC Description:	Bakeries and Tortilla Manufacturing

Jurisdiction of Incorporation:	Colorado Department of State
Incorporation Date:	2016-10-15
Company Identification Number:	20161695637
Legal Registered Office Address:	528 Zircon Way Superior United States of America (USA) 80027