401k Plan data: CUSTOM-PAK, INC. DISABILITY PLAN plan

CUSTOM-PAK, INC. DISABILITY PLAN 401k Plan overview

Plan Name	CUSTOM-PAK, INC. DISABILITY PLAN
Plan identification number	505

CUSTOM-PAK, INC. DISABILITY PLAN Benefits

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

401k Sponsoring company profile

CUSTOM PAK INC. has sponsored the creation of one or more 401k plans.

Company Name: CUSTOM PAK INC.

Employer identification number (EIN): 421022942

NAIC Classification: 326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CUSTOM-PAK, INC. DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2016-01-01 ANDREA LAWRENCE ANDREA LAWRENCE 2017-07-17
505 2016-01-01 ANDREA LAWRENCE 2020-04-27
505 2015-01-01 ANDREA LAWRENCE ANDREA LAWRENCE 2016-10-12
505 2014-01-01 ANDREA LAWRENCE ANDREA LAWRENCE 2015-10-07
505 2013-01-01 ANDREA LAWRENCE ANDREA LAWRENCE 2014-08-11
505 2012-01-01 ANDREA LAWRENCE ANDREA LAWRENCE 2013-09-30
505 2011-01-01 ANDREA LAWRENCE ANDREA LAWRENCE 2012-10-02
505 2009-04-01 ANDREA LAWRENCE ANDREA LAWRENCE 2010-10-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2016-01-01	ANDREA LAWRENCE		ANDREA LAWRENCE	2017-07-17
505	2016-01-01	ANDREA LAWRENCE	2020-04-27
505	2015-01-01	ANDREA LAWRENCE		ANDREA LAWRENCE	2016-10-12
505	2014-01-01	ANDREA LAWRENCE		ANDREA LAWRENCE	2015-10-07
505	2013-01-01	ANDREA LAWRENCE		ANDREA LAWRENCE	2014-08-11
505	2012-01-01	ANDREA LAWRENCE		ANDREA LAWRENCE	2013-09-30
505	2011-01-01	ANDREA LAWRENCE		ANDREA LAWRENCE	2012-10-02
505	2009-04-01	ANDREA LAWRENCE		ANDREA LAWRENCE	2010-10-05

Plan Statistics for CUSTOM-PAK, INC. DISABILITY PLAN

401k plan membership statisitcs for CUSTOM-PAK, INC. DISABILITY PLAN

Measure Date Value
2016: CUSTOM-PAK, INC. DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 743
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 788
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 788
Number of employers contributing to the scheme 2016-01-01 0
2015: CUSTOM-PAK, INC. DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 790
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 743
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 2015-01-01 743
2014: CUSTOM-PAK, INC. DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 825
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 770
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 2014-01-01 770
2013: CUSTOM-PAK, INC. DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 775
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 809
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 2013-01-01 809
2012: CUSTOM-PAK, INC. DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 757
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 762
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 2012-01-01 762
2011: CUSTOM-PAK, INC. DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 757
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 736
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 2011-01-01 736
2009: CUSTOM-PAK, INC. DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-04-01 663
Total number of active participants reported on line 7a of the Form 5500 2009-04-01 587
Number of retired or separated participants receiving benefits 2009-04-01 0
Number of other retired or separated participants entitled to future benefits 2009-04-01 0
Total of all active and inactive participants 2009-04-01 587

Measure	Date	Value
2016: CUSTOM-PAK, INC. DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	743
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	788
Number of retired or separated participants receiving benefits	2016-01-01	0
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	788
Number of employers contributing to the scheme	2016-01-01	0
2015: CUSTOM-PAK, INC. DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	790
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	743
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	743
2014: CUSTOM-PAK, INC. DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	825
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	770
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	770
2013: CUSTOM-PAK, INC. DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	775
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	809
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	809
2012: CUSTOM-PAK, INC. DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	757
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	762
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	762
2011: CUSTOM-PAK, INC. DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	757
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	736
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	736
2009: CUSTOM-PAK, INC. DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-04-01	663
Total number of active participants reported on line 7a of the Form 5500	2009-04-01	587
Number of retired or separated participants receiving benefits	2009-04-01	0
Number of other retired or separated participants entitled to future benefits	2009-04-01	0
Total of all active and inactive participants	2009-04-01	587

Form 5500 Responses for CUSTOM-PAK, INC. DISABILITY PLAN

2016: CUSTOM-PAK, INC. DISABILITY PLAN 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	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: CUSTOM-PAK, INC. DISABILITY PLAN 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: CUSTOM-PAK, INC. DISABILITY PLAN 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: CUSTOM-PAK, INC. DISABILITY PLAN 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: CUSTOM-PAK, INC. DISABILITY PLAN 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: CUSTOM-PAK, INC. DISABILITY PLAN 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
2009: CUSTOM-PAK, INC. DISABILITY PLAN 2009 form 5500 responses
2009-04-01	Type of plan entity	Single employer plan
2009-04-01	Plan funding arrangement – Insurance	Yes
2009-04-01	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

239501

Policy instance

Insurance contract or identification number	239501
Number of Individuals Covered	743
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $23,134
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	SHORT-TERM DISABILITY AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $231,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,134
Insurance broker organization code?	3
Insurance broker name	COTTINGHAM AND BUTLER INSURANCE

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	652
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $15,966
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $123,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,240
Insurance broker organization code?	3
Insurance broker name	MUTUAL MED INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	770
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $12,514
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,626
Insurance broker organization code?	3
Insurance broker name	MUTUAL MED INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	809
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,726
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,954
Insurance broker organization code?	3
Insurance broker name	MUTUAL MED INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	704
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $12,947
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,072
Insurance broker organization code?	3
Insurance broker name	MUTUAL MED INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	762
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,984
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,984
Insurance broker organization code?	3
Insurance broker name	MEL FOSTER CO INSURANCE

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	664
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $11,230
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $113,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,230
Insurance broker organization code?	3
Insurance broker name

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	736
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,441
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	635
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,918
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	646
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,638
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,638
Insurance broker organization code?	3
Insurance broker name	TRISSEL GRAHAM & TOOLE, INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H24579

Policy instance

Insurance contract or identification number	H24579
Number of Individuals Covered	763
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,253
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,253
Insurance broker organization code?	3
Insurance broker name	TRISSELL GRAHAM & TOOLE GROUP

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Company Name:	CUSTOM PAK INC.
Employer identification number (EIN):	421022942
NAIC Classification:	326100