401k Plan data: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE plan

CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 401k Plan overview

Plan Name	CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE
Plan identification number	515

CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: CLAYTON CORPORATION

Employer identification number (EIN): 430688018

NAIC Classification: 326100

Additional information about CLAYTON CORPORATION

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 0000-00-00

Company Identification Number: 189285

Legal Registered Office Address: 4429 N. EAST ST. LANSING

United States of America (USA)
48906

More information about CLAYTON CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
515 2015-01-01 DAVID F ORF
515 2014-01-01 DAVID F. ORF
515 2013-01-01 DAVID ORF
515 2012-01-01 DAVID ORF
515 2009-06-01 DAVID ORF

Plan id#	Filing Submission Date	Name of Administrator
515	2015-01-01	DAVID F ORF
515	2014-01-01	DAVID F. ORF
515	2013-01-01	DAVID ORF
515	2012-01-01	DAVID ORF
515	2009-06-01	DAVID ORF

Plan Statistics for CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE

401k plan membership statisitcs for CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE

Measure Date Value
2015: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2015 401k membership
Total participants, beginning-of-year 2015-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 251
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 2015-01-01 251
2014: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2014 401k membership
Total participants, beginning-of-year 2014-01-01 250
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 258
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 2014-01-01 258
2013: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2013 401k membership
Total participants, beginning-of-year 2013-01-01 249
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 250
Total of all active and inactive participants 2013-01-01 250
Total participants 2013-01-01 250
Number of employers contributing to the scheme 2013-01-01 0
2012: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2012 401k membership
Total participants, beginning-of-year 2012-01-01 232
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 249
Total of all active and inactive participants 2012-01-01 249
Total participants 2012-01-01 249
2009: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2009 401k membership
Total participants, beginning-of-year 2009-06-01 195
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 191
Total of all active and inactive participants 2009-06-01 191
Total participants 2009-06-01 191

Measure	Date	Value
2015: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2015 401k membership
Total participants, beginning-of-year	2015-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	251
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	251
2014: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2014 401k membership
Total participants, beginning-of-year	2014-01-01	250
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	258
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	258
2013: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2013 401k membership
Total participants, beginning-of-year	2013-01-01	249
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	250
Total of all active and inactive participants	2013-01-01	250
Total participants	2013-01-01	250
Number of employers contributing to the scheme	2013-01-01	0
2012: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2012 401k membership
Total participants, beginning-of-year	2012-01-01	232
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	249
Total of all active and inactive participants	2012-01-01	249
Total participants	2012-01-01	249
2009: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2009 401k membership
Total participants, beginning-of-year	2009-06-01	195
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	191
Total of all active and inactive participants	2009-06-01	191
Total participants	2009-06-01	191

Form 5500 Responses for CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE

2015: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 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: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 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: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
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: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
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
2009: CLAYTON CORPORATION GROUP TERM LIFE AND ADD INSURANCE 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	Submission has been amended	No
2009-06-01	This submission is the final filing	No
2009-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2009-06-01	Plan is a collectively bargained plan	No
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10183453

Policy instance

Insurance contract or identification number	10183453
Number of Individuals Covered	251
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,693
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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	Yes
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 $44,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,693
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH AND BENEFITS, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10183453

Policy instance

Insurance contract or identification number	10183453
Number of Individuals Covered	258
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,500
Total amount of fees paid to insurance company	USD $2,123
Are there contracts with allocated funds for individual policies?	No
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	Yes
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 $43,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,852
Insurance broker organization code?	3
Amount paid for insurance broker fees	2123
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	JW TERRILL BENEFIT SERVICES INC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5456454

Policy instance

Insurance contract or identification number	5456454
Number of Individuals Covered	250
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,480
Total amount of fees paid to insurance company	USD $2,255
Are there contracts with allocated funds for individual policies?	No
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	Yes
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 $44,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,480
Amount paid for insurance broker fees	2255
Insurance broker organization code?	3
Insurance broker name	JW TERRILL BENEFIT SERVICES INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5456454

Policy instance

Insurance contract or identification number	5456454
Number of Individuals Covered	249
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,789
Total amount of fees paid to insurance company	USD $1,155
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $38,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,789
Amount paid for insurance broker fees	1155
Insurance broker organization code?	3
Insurance broker name	JW TERRILL BENEFIT SERVICES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL-137066

Policy instance

Insurance contract or identification number	GL-137066
Number of Individuals Covered	211
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,705
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,705
Insurance broker name	JW TERRILL BENEFIT SERVICES INC.

Potentially related plans

CLAYTON CORPORATION 401 K PROFIT SHARING PLAN TRUST [EIN = 391896697]

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Company Name:	CLAYTON CORPORATION
Employer identification number (EIN):	430688018
NAIC Classification:	326100

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	0000-00-00
Company Identification Number:	189285
Legal Registered Office Address:	4429 N. EAST ST. LANSING United States of America (USA) 48906