401k Plan data: ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN plan

ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN
Plan identification number	502

ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE 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)

401k Sponsoring company profile

SOUTHWEST NURSERY & SUPPLY, LLC has sponsored the creation of one or more 401k plans.

Company Name: SOUTHWEST NURSERY & SUPPLY, LLC

Employer identification number (EIN): 362598882

NAIC Classification: 111400
NAIC Description: Greenhouse, Nursery, and Floriculture Production

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2014-07-01 PATRICK EARLEY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2014-07-01	PATRICK EARLEY

Plan Statistics for ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN

401k plan membership statisitcs for ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN

Measure Date Value
2014: ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 247
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 241
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 241

Measure	Date	Value
2014: ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	247
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	241
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	241

Form 5500 Responses for ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN

2014: ILLINOIS CENTRAL SCHOOL BUS HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	First time form 5500 has been submitted	Yes
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000020745

Policy instance

Insurance contract or identification number	0000020745
Number of Individuals Covered	224
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $45,316
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $82,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,066
Insurance broker organization code?	3
Insurance broker name	EOI SERVICE COMPANY

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00491187

Policy instance

Insurance contract or identification number	00491187
Number of Individuals Covered	125
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $7,948
Total amount of fees paid to insurance company	USD $4,735
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,948
Amount paid for insurance broker fees	4735
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AQT1

Policy instance

Insurance contract or identification number	GLUG0AQT1
Number of Individuals Covered	242
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $4,147
Total amount of fees paid to insurance company	USD $247
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $27,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,147
Amount paid for insurance broker fees	247
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUPR0AQT1

Policy instance

Insurance contract or identification number	GUPR0AQT1
Number of Individuals Covered	78
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $4,371
Total amount of fees paid to insurance company	USD $209
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,371
Amount paid for insurance broker fees	209
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AQT1

Policy instance

Insurance contract or identification number	GVTL0AQT1
Number of Individuals Covered	81
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $5,349
Total amount of fees paid to insurance company	USD $256
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $35,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,349
Amount paid for insurance broker fees	256
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

624,346,624,642

Policy instance

Insurance contract or identification number	624,346,624,642
Number of Individuals Covered	176
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $39,095
Total amount of fees paid to insurance company	USD $2,050
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $990,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,095
Amount paid for insurance broker fees	2050
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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Company Name:	SOUTHWEST NURSERY & SUPPLY, LLC
Employer identification number (EIN):	362598882
NAIC Classification:	111400
NAIC Description:	Greenhouse, Nursery, and Floriculture Production