401k Plan data: PLYMOUTH PACKAGING INC. BCBS-HSA plan

PLYMOUTH PACKAGING INC. BCBS-HSA 401k Plan overview

Plan Name	PLYMOUTH PACKAGING INC. BCBS-HSA
Plan identification number	505

PLYMOUTH PACKAGING INC. BCBS-HSA Benefits

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

401k Sponsoring company profile

PLYMOUTH PACKAGING INC has sponsored the creation of one or more 401k plans.

Company Name: PLYMOUTH PACKAGING INC

Employer identification number (EIN): 383006868

NAIC Classification: 322200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PLYMOUTH PACKAGING INC. BCBS-HSA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2017-01-01 NANCY HARRISON NANCY HARRISON 2018-08-08
505 2016-01-01 NANCY HARRISON NANCY HARRISON 2017-07-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2017-01-01	NANCY HARRISON		NANCY HARRISON	2018-08-08
505	2016-01-01	NANCY HARRISON		NANCY HARRISON	2017-07-27

Plan Statistics for PLYMOUTH PACKAGING INC. BCBS-HSA

401k plan membership statisitcs for PLYMOUTH PACKAGING INC. BCBS-HSA

Measure Date Value
2017: PLYMOUTH PACKAGING INC. BCBS-HSA 2017 401k membership
Total participants, beginning-of-year 2017-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 128
Total of all active and inactive participants 2017-01-01 128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 129
2016: PLYMOUTH PACKAGING INC. BCBS-HSA 2016 401k membership
Total participants, beginning-of-year 2016-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 231
Total of all active and inactive participants 2016-01-01 231
Total participants 2016-01-01 231

Measure	Date	Value
2017: PLYMOUTH PACKAGING INC. BCBS-HSA 2017 401k membership
Total participants, beginning-of-year	2017-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	128
Total of all active and inactive participants	2017-01-01	128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	129
2016: PLYMOUTH PACKAGING INC. BCBS-HSA 2016 401k membership
Total participants, beginning-of-year	2016-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	231
Total of all active and inactive participants	2016-01-01	231
Total participants	2016-01-01	231

Form 5500 Responses for PLYMOUTH PACKAGING INC. BCBS-HSA

2017: PLYMOUTH PACKAGING INC. BCBS-HSA 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: PLYMOUTH PACKAGING INC. BCBS-HSA 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	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

151557

Policy instance

Insurance contract or identification number	151557
Number of Individuals Covered	264
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $30,558
Total amount of fees paid to insurance company	USD $1,837
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
Commission paid to Insurance Broker	USD $30,558
Amount paid for insurance broker fees	1837
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS PAID
Insurance broker organization code?	3
Insurance broker name	MEADOWBROOK INC

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Company Name:	PLYMOUTH PACKAGING INC
Employer identification number (EIN):	383006868
NAIC Classification:	322200