401k Plan data: AULTCARE plan

AULTCARE 401k Plan overview

Plan Name	AULTCARE
Plan identification number	501

AULTCARE Benefits

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

401k Sponsoring company profile

HUMBERT SCREEN GRAPHIX LLC has sponsored the creation of one or more 401k plans.

Company Name: HUMBERT SCREEN GRAPHIX LLC

Employer identification number (EIN): 341401267

NAIC Classification: 541400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AULTCARE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 TIM HUMBERT
501 2016-08-01 TIM HUMBERT TIM HUMBERT 2017-08-09
501 2015-08-01 TIM HUMBERT 2016-09-08 TIM HUMBERT 2016-09-08
501 2014-08-01 TIM HUMBERT 2015-09-08 TIM HUMBERT 2015-09-08
501 2013-08-01 TIM HUMBERT 2014-09-23 TIM HUMBERT 2014-09-23
501 2012-08-01 TIM HUMBERT 2013-09-09 TIM HUMBERT 2013-09-09
501 2011-08-01 TIM HUMBERT 2012-09-25 TIM HUMBERT 2012-09-25
501 2009-08-01 TIM HUMBERT 2010-08-26 TIM HUMBERT 2010-08-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-01-01
501	2019-01-01
501	2018-01-01
501	2017-01-01	TIM HUMBERT
501	2016-08-01	TIM HUMBERT		TIM HUMBERT	2017-08-09
501	2015-08-01	TIM HUMBERT	2016-09-08	TIM HUMBERT	2016-09-08
501	2014-08-01	TIM HUMBERT	2015-09-08	TIM HUMBERT	2015-09-08
501	2013-08-01	TIM HUMBERT	2014-09-23	TIM HUMBERT	2014-09-23
501	2012-08-01	TIM HUMBERT	2013-09-09	TIM HUMBERT	2013-09-09
501	2011-08-01	TIM HUMBERT	2012-09-25	TIM HUMBERT	2012-09-25
501	2009-08-01	TIM HUMBERT	2010-08-26	TIM HUMBERT	2010-08-26

Plan Statistics for AULTCARE

401k plan membership statisitcs for AULTCARE

Measure Date Value
2020: AULTCARE 2020 401k membership
Total participants, beginning-of-year 2020-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 3
Total of all active and inactive participants 2020-01-01 3
Total participants 2020-01-01 3
2019: AULTCARE 2019 401k membership
Total participants, beginning-of-year 2019-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 4
Total of all active and inactive participants 2019-01-01 4
Total participants 2019-01-01 4
2018: AULTCARE 2018 401k membership
Total participants, beginning-of-year 2018-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 5
Total of all active and inactive participants 2018-01-01 5
Total participants 2018-01-01 5
2017: AULTCARE 2017 401k membership
Total participants, beginning-of-year 2017-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 5
Total of all active and inactive participants 2017-01-01 5
Total participants 2017-01-01 5
2016: AULTCARE 2016 401k membership
Total participants, beginning-of-year 2016-08-01 5
Total number of active participants reported on line 7a of the Form 5500 2016-08-01 5
Total of all active and inactive participants 2016-08-01 5
Total participants 2016-08-01 5
2015: AULTCARE 2015 401k membership
Total participants, beginning-of-year 2015-08-01 7
Total number of active participants reported on line 7a of the Form 5500 2015-08-01 5
Total of all active and inactive participants 2015-08-01 5
Total participants 2015-08-01 5
2014: AULTCARE 2014 401k membership
Total participants, beginning-of-year 2014-08-01 6
Total number of active participants reported on line 7a of the Form 5500 2014-08-01 5
Total of all active and inactive participants 2014-08-01 5
Total participants 2014-08-01 5
2013: AULTCARE 2013 401k membership
Total participants, beginning-of-year 2013-08-01 5
Total number of active participants reported on line 7a of the Form 5500 2013-08-01 6
Total of all active and inactive participants 2013-08-01 6
Total participants 2013-08-01 6
2012: AULTCARE 2012 401k membership
Total participants, beginning-of-year 2012-08-01 5
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 5
Total of all active and inactive participants 2012-08-01 5
Total participants 2012-08-01 5
2011: AULTCARE 2011 401k membership
Total participants, beginning-of-year 2011-08-01 5
Total number of active participants reported on line 7a of the Form 5500 2011-08-01 5
Total of all active and inactive participants 2011-08-01 5
Total participants 2011-08-01 5
2009: AULTCARE 2009 401k membership
Total participants, beginning-of-year 2009-08-01 7
Total number of active participants reported on line 7a of the Form 5500 2009-08-01 5
Total of all active and inactive participants 2009-08-01 5
Total participants 2009-08-01 5

Measure	Date	Value
2020: AULTCARE 2020 401k membership
Total participants, beginning-of-year	2020-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	3
Total of all active and inactive participants	2020-01-01	3
Total participants	2020-01-01	3
2019: AULTCARE 2019 401k membership
Total participants, beginning-of-year	2019-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	4
Total of all active and inactive participants	2019-01-01	4
Total participants	2019-01-01	4
2018: AULTCARE 2018 401k membership
Total participants, beginning-of-year	2018-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	5
Total of all active and inactive participants	2018-01-01	5
Total participants	2018-01-01	5
2017: AULTCARE 2017 401k membership
Total participants, beginning-of-year	2017-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	5
Total of all active and inactive participants	2017-01-01	5
Total participants	2017-01-01	5
2016: AULTCARE 2016 401k membership
Total participants, beginning-of-year	2016-08-01	5
Total number of active participants reported on line 7a of the Form 5500	2016-08-01	5
Total of all active and inactive participants	2016-08-01	5
Total participants	2016-08-01	5
2015: AULTCARE 2015 401k membership
Total participants, beginning-of-year	2015-08-01	7
Total number of active participants reported on line 7a of the Form 5500	2015-08-01	5
Total of all active and inactive participants	2015-08-01	5
Total participants	2015-08-01	5
2014: AULTCARE 2014 401k membership
Total participants, beginning-of-year	2014-08-01	6
Total number of active participants reported on line 7a of the Form 5500	2014-08-01	5
Total of all active and inactive participants	2014-08-01	5
Total participants	2014-08-01	5
2013: AULTCARE 2013 401k membership
Total participants, beginning-of-year	2013-08-01	5
Total number of active participants reported on line 7a of the Form 5500	2013-08-01	6
Total of all active and inactive participants	2013-08-01	6
Total participants	2013-08-01	6
2012: AULTCARE 2012 401k membership
Total participants, beginning-of-year	2012-08-01	5
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	5
Total of all active and inactive participants	2012-08-01	5
Total participants	2012-08-01	5
2011: AULTCARE 2011 401k membership
Total participants, beginning-of-year	2011-08-01	5
Total number of active participants reported on line 7a of the Form 5500	2011-08-01	5
Total of all active and inactive participants	2011-08-01	5
Total participants	2011-08-01	5
2009: AULTCARE 2009 401k membership
Total participants, beginning-of-year	2009-08-01	7
Total number of active participants reported on line 7a of the Form 5500	2009-08-01	5
Total of all active and inactive participants	2009-08-01	5
Total participants	2009-08-01	5

Financial Data on AULTCARE

Measure	Date	Value
2020 : AULTCARE 2020 401k financial data
Transfers to/from the plan	2020-12-31	$4
Total plan liabilities at end of year	2020-12-31	$2,832
Total plan liabilities at beginning of year	2020-12-31	$2,790
Total income from all sources	2020-12-31	$27,338
Expenses. Total of all expenses incurred	2020-12-31	$24,689
Benefits paid (including direct rollovers)	2020-12-31	$14
Total plan assets at end of year	2020-12-31	$11,677
Total plan assets at beginning of year	2020-12-31	$8,982
Value of fidelity bond covering the plan	2020-12-31	$1,000,000
Total contributions received or receivable from participants	2020-12-31	$19,113
Expenses. Other expenses not covered elsewhere	2020-12-31	$20
Net income (gross income less expenses)	2020-12-31	$2,649
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$8,845
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$6,192
Total contributions received or receivable from employer(s)	2020-12-31	$8,225
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$24,655

Form 5500 Responses for AULTCARE

2020: AULTCARE 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: AULTCARE 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: AULTCARE 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: AULTCARE 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: AULTCARE 2016 form 5500 responses
2016-08-01	Type of plan entity	Single employer plan
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
2015: AULTCARE 2015 form 5500 responses
2015-08-01	Type of plan entity	Single employer plan
2015-08-01	Plan funding arrangement – Insurance	Yes
2015-08-01	Plan benefit arrangement – Insurance	Yes
2014: AULTCARE 2014 form 5500 responses
2014-08-01	Type of plan entity	Single employer plan
2014-08-01	Plan funding arrangement – Insurance	Yes
2014-08-01	Plan benefit arrangement – Insurance	Yes
2013: AULTCARE 2013 form 5500 responses
2013-08-01	Type of plan entity	Single employer plan
2013-08-01	Plan funding arrangement – Insurance	Yes
2013-08-01	Plan benefit arrangement – Insurance	Yes
2012: AULTCARE 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2011: AULTCARE 2011 form 5500 responses
2011-08-01	Type of plan entity	Single employer plan
2011-08-01	Plan funding arrangement – Insurance	Yes
2011-08-01	Plan benefit arrangement – Insurance	Yes
2009: AULTCARE 2009 form 5500 responses
2009-08-01	Type of plan entity	Single employer plan
2009-08-01	Plan funding arrangement – Insurance	Yes
2009-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MCKINLEY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77216 )

Policy contract number

HF1095

Policy instance

Insurance contract or identification number	HF1095
Number of Individuals Covered	4
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $900
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

MCKINLEY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77216 )

Policy contract number

HF1095

Policy instance

Insurance contract or identification number	HF1095
Number of Individuals Covered	5
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $101,670
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
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 $29,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,016

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Company Name:	HUMBERT SCREEN GRAPHIX LLC
Employer identification number (EIN):	341401267
NAIC Classification:	541400