401k Plan data: PRISM PLASTICS, INC. GROUP INSURANCE PLAN plan

PRISM PLASTICS, INC. GROUP INSURANCE PLAN 401k Plan overview

Plan Name	PRISM PLASTICS, INC. GROUP INSURANCE PLAN
Plan identification number	501

PRISM PLASTICS, INC. GROUP INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Supplemental unemployment Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

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

Company Name: PRISM PLASTICS, INC.

Employer identification number (EIN): 371753874

NAIC Classification: 326100

Additional information about PRISM PLASTICS, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2014-04-24

Company Identification Number: 0801977528

Legal Registered Office Address: 181 W MADISON ST STE 3900

CHICAGO
United States of America (USA)
60602

More information about PRISM PLASTICS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRISM PLASTICS, INC. GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 REBEKAH MERRITT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2017-01-01	REBEKAH MERRITT

Plan Statistics for PRISM PLASTICS, INC. GROUP INSURANCE PLAN

401k plan membership statisitcs for PRISM PLASTICS, INC. GROUP INSURANCE PLAN

Measure Date Value
2017: PRISM PLASTICS, INC. GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 204
Total of all active and inactive participants 2017-01-01 204

Measure	Date	Value
2017: PRISM PLASTICS, INC. GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	204
Total of all active and inactive participants	2017-01-01	204

Form 5500 Responses for PRISM PLASTICS, INC. GROUP INSURANCE PLAN

2017: PRISM PLASTICS, INC. GROUP INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5939987

Policy instance

Insurance contract or identification number	5939987
Number of Individuals Covered	399
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $40,161
Total amount of fees paid to insurance company	USD $22,740
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $292,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,774
Insurance broker organization code?	3
Amount paid for insurance broker fees	9353
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker name	BOON CHAPMAN BENEFIT ADMINISTRATORS

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

416826

Policy instance

Insurance contract or identification number	416826
Number of Individuals Covered	371
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $45,617
Total amount of fees paid to insurance company	USD $1,966
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,617
Amount paid for insurance broker fees	1966
Additional information about fees paid to insurance broker	ADMIN FEES
Insurance broker organization code?	3
Insurance broker name	ROBERT J. REAUME

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Company Name:	PRISM PLASTICS, INC.
Employer identification number (EIN):	371753874
NAIC Classification:	326100

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2014-04-24
Company Identification Number:	0801977528
Legal Registered Office Address:	181 W MADISON ST STE 3900 CHICAGO United States of America (USA) 60602