401k Plan data: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK plan

CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 401k Plan overview

Plan Name	CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK
Plan identification number	501

CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

CLACK CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: CLACK CORPORATION

Employer identification number (EIN): 390916000

NAIC Classification: 326100

Additional information about CLACK CORPORATION

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C2861477

More information about CLACK CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-01-01
501 2017-01-01 MATTHEW REID MATTHEW REID 2018-10-15
501 2016-01-01 DAVID WILLIAMS DAVID WILLIAMS 2017-10-19
501 2016-01-01 DAVID WILLIAMS 2017-10-16
501 2016-01-01 DAVID WILLIAM 2017-10-16
501 2015-01-01 DAVID WILLIAMS
501 2014-01-01 DAVID WILLIAMS
501 2013-01-01 DAVID WILLIAMS
501 2012-01-01 DAVID WILLIAMS
501 2011-01-01 DAVID WILLIAMS
501 2010-01-01 DAVID WILLIAMS
501 2009-01-01 DAVID WILLIAMS
501 2009-01-01 DAVID WILLIAMS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2018-01-01
501	2017-01-01	MATTHEW REID	MATTHEW REID	2018-10-15
501	2016-01-01	DAVID WILLIAMS	DAVID WILLIAMS	2017-10-19
501	2016-01-01		DAVID WILLIAMS	2017-10-16
501	2016-01-01		DAVID WILLIAM	2017-10-16
501	2015-01-01	DAVID WILLIAMS
501	2014-01-01	DAVID WILLIAMS
501	2013-01-01	DAVID WILLIAMS
501	2012-01-01	DAVID WILLIAMS
501	2011-01-01	DAVID WILLIAMS
501	2010-01-01	DAVID WILLIAMS
501	2009-01-01	DAVID WILLIAMS
501	2009-01-01	DAVID WILLIAMS

Plan Statistics for CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK

401k plan membership statisitcs for CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK

Measure Date Value
2018: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2018 401k membership
Total participants, beginning-of-year 2018-01-01 330
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 377
Number of retired or separated participants receiving benefits 2018-01-01 1
Total of all active and inactive participants 2018-01-01 378
2017: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2017 401k membership
Total participants, beginning-of-year 2017-01-01 313
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 335
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 335
2016: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2016 401k membership
Total participants, beginning-of-year 2016-01-01 344
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 313
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 313
2015: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2015 401k membership
Total participants, beginning-of-year 2015-01-01 289
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 344
Total of all active and inactive participants 2015-01-01 344
Total participants 2015-01-01 0
2014: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2014 401k membership
Total participants, beginning-of-year 2014-01-01 267
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 289
Total of all active and inactive participants 2014-01-01 289
Total participants 2014-01-01 0
2013: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2013 401k membership
Total participants, beginning-of-year 2013-01-01 256
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 267
Total of all active and inactive participants 2013-01-01 267
Total participants 2013-01-01 0
2012: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2012 401k membership
Total participants, beginning-of-year 2012-01-01 254
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 256
Total of all active and inactive participants 2012-01-01 256
Total participants 2012-01-01 0
2011: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2011 401k membership
Total participants, beginning-of-year 2011-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 254
Total of all active and inactive participants 2011-01-01 254
Total participants 2011-01-01 254
2010: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2010 401k membership
Total participants, beginning-of-year 2010-01-01 248
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 247
Total of all active and inactive participants 2010-01-01 247
Total participants 2010-01-01 247
2009: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2009 401k membership
Total participants, beginning-of-year 2009-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 248
Total of all active and inactive participants 2009-01-01 248
Total participants 2009-01-01 248

Measure	Date	Value
2018: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2018 401k membership
Total participants, beginning-of-year	2018-01-01	330
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	377
Number of retired or separated participants receiving benefits	2018-01-01	1
Total of all active and inactive participants	2018-01-01	378
2017: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2017 401k membership
Total participants, beginning-of-year	2017-01-01	313
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	335
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	335
2016: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2016 401k membership
Total participants, beginning-of-year	2016-01-01	344
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	313
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	313
2015: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2015 401k membership
Total participants, beginning-of-year	2015-01-01	289
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	344
Total of all active and inactive participants	2015-01-01	344
Total participants	2015-01-01	0
2014: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2014 401k membership
Total participants, beginning-of-year	2014-01-01	267
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	289
Total of all active and inactive participants	2014-01-01	289
Total participants	2014-01-01	0
2013: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2013 401k membership
Total participants, beginning-of-year	2013-01-01	256
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	267
Total of all active and inactive participants	2013-01-01	267
Total participants	2013-01-01	0
2012: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2012 401k membership
Total participants, beginning-of-year	2012-01-01	254
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	256
Total of all active and inactive participants	2012-01-01	256
Total participants	2012-01-01	0
2011: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2011 401k membership
Total participants, beginning-of-year	2011-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	254
Total of all active and inactive participants	2011-01-01	254
Total participants	2011-01-01	254
2010: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2010 401k membership
Total participants, beginning-of-year	2010-01-01	248
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	247
Total of all active and inactive participants	2010-01-01	247
Total participants	2010-01-01	247
2009: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2009 401k membership
Total participants, beginning-of-year	2009-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	248
Total of all active and inactive participants	2009-01-01	248
Total participants	2009-01-01	248

Form 5500 Responses for CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK

2018: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 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: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 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: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
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
2015: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: CLACK CORPORATION GROUP INSURANCE HEALTH-LIFE TEMP ACCIDENT & SICK 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

00507168

Policy instance

Insurance contract or identification number	00507168
Number of Individuals Covered	335
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $9,493
Total amount of fees paid to insurance company	USD $1,352
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $141,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,493
Amount paid for insurance broker fees	1352
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	HEMB INSURANCE GROUP

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Company Name:	CLACK CORPORATION
Employer identification number (EIN):	390916000
NAIC Classification:	326100

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C2861477