401k Plan data: FOREMAN BROS.,INC. WELFARE BENEFIT PLAN plan

FOREMAN BROS.,INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	FOREMAN BROS.,INC. WELFARE BENEFIT PLAN
Plan identification number	501

FOREMAN BROS.,INC. WELFARE BENEFIT 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) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: FOREMAN BROS., INC.

Employer identification number (EIN): 381402251

NAIC Classification: 484200
NAIC Description: Specialized Freight Trucking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOREMAN BROS.,INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-04-01 SARA TUBBS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2017-04-01	SARA TUBBS

Plan Statistics for FOREMAN BROS.,INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for FOREMAN BROS.,INC. WELFARE BENEFIT PLAN

Measure Date Value
2017: FOREMAN BROS.,INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-01 102
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 100
Total of all active and inactive participants 2017-04-01 100

Measure	Date	Value
2017: FOREMAN BROS.,INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-01	102
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	100
Total of all active and inactive participants	2017-04-01	100

Form 5500 Responses for FOREMAN BROS.,INC. WELFARE BENEFIT PLAN

2017: FOREMAN BROS.,INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Submission has been amended	No
2017-04-01	This submission is the final filing	No
2017-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-04-01	Plan is a collectively bargained plan	No
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

104451

Policy instance

Insurance contract or identification number	104451
Number of Individuals Covered	27
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $8,025
Total amount of fees paid to insurance company	USD $62
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 $652
Insurance broker organization code?	3
Amount paid for insurance broker fees	62
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSION
Insurance broker name	DANIEL STAFFORD

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010041847

Policy instance

Insurance contract or identification number	010041847
Number of Individuals Covered	215
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $4,510
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,835
Insurance broker organization code?	3
Insurance broker name	STAFFORD FINANCIAL CONSULTING GROUP

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

104451

Policy instance

Insurance contract or identification number	104451
Number of Individuals Covered	110
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $26,214
Total amount of fees paid to insurance company	USD $334
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 $2,092
Insurance broker organization code?	3
Amount paid for insurance broker fees	334
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSION
Insurance broker name	DANIEL STAFFORD

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

EAB1000018

Policy instance

Insurance contract or identification number	EAB1000018
Number of Individuals Covered	100
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $3,055
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $20,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,822
Insurance broker organization code?	3
Insurance broker name	M3 INSURANCE SOLUTIONS, INC.

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Company Name:	FOREMAN BROS., INC.
Employer identification number (EIN):	381402251
NAIC Classification:	484200
NAIC Description:	Specialized Freight Trucking