401k Plan data: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT plan

SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 401k Plan overview

Plan Name	SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT
Plan identification number	506

SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: MENASHA CORPORATION

Employer identification number (EIN): 391367484

NAIC Classification: 322100

Additional information about MENASHA CORPORATION

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1983-09-05

Company Identification Number: 0008091506

Legal Registered Office Address: 1645 BERGSTROM RD

NEENAH
United States of America (USA)
54956

More information about MENASHA CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2017-01-01 ALYSIA FABRICIUS
506 2017-01-01
506 2016-01-01 ALYSIA FABRICIUS
506 2015-01-01 JENNIFER GREENINGER JENNIFER GREENINGER 2016-07-25
506 2014-01-01 JENNIFER GREENINGER JENNIFER GREENINGER 2015-07-24
506 2013-01-01 DORIS DEBRUIN DORIS DEBRUIN 2014-07-01
506 2012-01-01 DORIS DEBRUIN DORIS DEBRUIN 2013-06-28
506 2011-01-01 DORIS DEBRUIN
506 2009-01-01 MARY ZITO LORI KARLS 2010-06-18

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
506	2017-01-01	ALYSIA FABRICIUS
506	2017-01-01
506	2016-01-01	ALYSIA FABRICIUS
506	2015-01-01	JENNIFER GREENINGER	JENNIFER GREENINGER	2016-07-25
506	2014-01-01	JENNIFER GREENINGER	JENNIFER GREENINGER	2015-07-24
506	2013-01-01	DORIS DEBRUIN	DORIS DEBRUIN	2014-07-01
506	2012-01-01	DORIS DEBRUIN	DORIS DEBRUIN	2013-06-28
506	2011-01-01	DORIS DEBRUIN
506	2009-01-01	MARY ZITO	LORI KARLS	2010-06-18

Plan Statistics for SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT

401k plan membership statisitcs for SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT

Measure Date Value
2017: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,848
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,759
Total of all active and inactive participants 2017-01-01 1,759
Total participants 2017-01-01 1,759
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
2016: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,842
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,758
Total of all active and inactive participants 2016-01-01 1,758
Total participants 2016-01-01 1,758
2015: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,815
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,759
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 1,759
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1,759
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
Number of employers contributing to the scheme 2015-01-01 0
2014: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,315
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,589
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 1,589
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 1,589
Number of participants with account balances 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
Number of employers contributing to the scheme 2014-01-01 0
2013: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,182
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,185
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 1,185
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 1,185
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,159
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,133
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 1,133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 1,133
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
Number of employers contributing to the scheme 2012-01-01 0
2011: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,166
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,112
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 1,112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1,112
2009: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,104
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 955
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 955
Total participants 2009-01-01 955

Measure	Date	Value
2017: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,848
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,759
Total of all active and inactive participants	2017-01-01	1,759
Total participants	2017-01-01	1,759
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
2016: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,842
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,758
Total of all active and inactive participants	2016-01-01	1,758
Total participants	2016-01-01	1,758
2015: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,815
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,759
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1,759
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1,759
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
Number of employers contributing to the scheme	2015-01-01	0
2014: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,315
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,589
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	1,589
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	1,589
Number of participants with account balances	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
Number of employers contributing to the scheme	2014-01-01	0
2013: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,182
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,185
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	1,185
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	1,185
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,159
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,133
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	1,133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	1,133
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
Number of employers contributing to the scheme	2012-01-01	0
2011: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,166
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,112
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	1,112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1,112
2009: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,104
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	955
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	955
Total participants	2009-01-01	955

Form 5500 Responses for SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT

2017: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 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: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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
2015: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK966638

Policy instance

Insurance contract or identification number	OK966638
Number of Individuals Covered	1848
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $21,355
Total amount of fees paid to insurance company	USD $1,997
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	No
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $142,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,355
Amount paid for insurance broker fees	1997
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HAYS COMPANIES

Potentially related plans

SUPPLEMENTAL ACCIDENTAL DEATH & DISMEMBERMENT [EIN = 591943502]

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Company Name:	MENASHA CORPORATION
Employer identification number (EIN):	391367484
NAIC Classification:	322100

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1983-09-05
Company Identification Number:	0008091506
Legal Registered Office Address:	1645 BERGSTROM RD NEENAH United States of America (USA) 54956