401k Plan data: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN plan

SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 401k Plan overview

Plan Name	SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN
Plan identification number	501

SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN Benefits

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

401k Sponsoring company profile

SOUTHWESTERN FURNITURE OF WISCONSIN , LLC has sponsored the creation of one or more 401k plans.

Company Name: SOUTHWESTERN FURNITURE OF WISCONSIN , LLC

Employer identification number (EIN): 392031155

NAIC Classification: 337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 WALLACE JONES
501 2015-01-01 WALLACE JONES
501 2014-01-01 MARCUS GAGNON MARCUS GAGNON 2015-06-26
501 2013-01-01 CAREY MACLENNAN CAREY MACLENNAN 2014-07-29
501 2012-01-01 CAREY MACLENNAN CAREY MACLENNAN 2013-07-26
501 2011-01-01 RONALD E PUGH
501 2009-01-01 RONALD E PUGH
501 2009-01-01 RONALD E PUGH 2010-09-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	WALLACE JONES
501	2015-01-01	WALLACE JONES
501	2014-01-01	MARCUS GAGNON	MARCUS GAGNON	2015-06-26
501	2013-01-01	CAREY MACLENNAN	CAREY MACLENNAN	2014-07-29
501	2012-01-01	CAREY MACLENNAN	CAREY MACLENNAN	2013-07-26
501	2011-01-01	RONALD E PUGH
501	2009-01-01	RONALD E PUGH
501	2009-01-01		RONALD E PUGH	2010-09-15

Plan Statistics for SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN

401k plan membership statisitcs for SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN

Measure Date Value
2015: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 354
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 288
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 2015-01-01 288
2014: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 459
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 354
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 2014-01-01 354
2013: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 617
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 459
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 2013-01-01 459
2012: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 478
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 617
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 2012-01-01 617
Total participants 2012-01-01 617
2011: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 554
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 478
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 2011-01-01 478
2009: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 546
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 498
Number of retired or separated participants receiving benefits 2009-01-01 6
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 504

Measure	Date	Value
2015: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	354
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	288
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	288
2014: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	459
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	354
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	354
2013: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	617
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	459
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	459
2012: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	478
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	617
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	617
Total participants	2012-01-01	617
2011: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	554
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	478
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	478
2009: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	546
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	498
Number of retired or separated participants receiving benefits	2009-01-01	6
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	504

Form 5500 Responses for SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN

2015: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 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 funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: SOUTHWESTERN FURNITURE OF WISCONSIN, LLC MEDICAL & DENTAL PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	238322
Policy instance	1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30048334
Policy instance	2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 54682 )
Policy contract number	30048334
Policy instance	1
HEALTH NET OF AZ (National Association of Insurance Commissioners NAIC id number: 95206 )
Policy contract number	Z09886
Policy instance	1
HEALTH NET OF AZ (National Association of Insurance Commissioners NAIC id number: 95206 )
Policy contract number	Z09886
Policy instance	1
SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )
Policy contract number	10002262
Policy instance	3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	230275
Policy instance	2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	484824
Policy instance	1
HEALTH NET OF AZ (National Association of Insurance Commissioners NAIC id number: 95206 )
Policy contract number	Z09886
Policy instance	4
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	484824
Policy instance	4
HEALTH NET OF AZ (National Association of Insurance Commissioners NAIC id number: 95206 )
Policy contract number	Z09886
Policy instance	3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	230275
Policy instance	1
SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )
Policy contract number	10002262
Policy instance	2

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Company Name:	SOUTHWESTERN FURNITURE OF WISCONSIN , LLC
Employer identification number (EIN):	392031155
NAIC Classification:	337000