401k Plan data: AP GREEN PRYOR HEALTH AND WELFARE PLAN plan

AP GREEN PRYOR HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	AP GREEN PRYOR HEALTH AND WELFARE PLAN
Plan identification number	532

AP GREEN PRYOR HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

HARBISONWALKER INTERNATIONAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: HARBISONWALKER INTERNATIONAL, INC.

Employer identification number (EIN): 431680037

NAIC Classification: 327100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AP GREEN PRYOR HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
532 2015-01-01 JUDY WEISSEG
532 2014-01-01 JUDY WEISSEG
532 2013-01-01 JUDY WEISSEG JUDY WEISSEG 2014-10-13
532 2012-01-01 JUDY WEISSEG JUDY WEISSEG 2013-07-30
532 2011-01-01 JUDY WEISSEG JUDY WEISSEG 2012-10-09
532 2010-01-01 JUDY WEISSEG JUDY WEISSEG 2011-09-22
532 2009-01-01 JUDY WEISSEG JUDY WEISSEG 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
532	2015-01-01	JUDY WEISSEG
532	2014-01-01	JUDY WEISSEG
532	2013-01-01	JUDY WEISSEG	JUDY WEISSEG	2014-10-13
532	2012-01-01	JUDY WEISSEG	JUDY WEISSEG	2013-07-30
532	2011-01-01	JUDY WEISSEG	JUDY WEISSEG	2012-10-09
532	2010-01-01	JUDY WEISSEG	JUDY WEISSEG	2011-09-22
532	2009-01-01	JUDY WEISSEG	JUDY WEISSEG	2010-10-13

Plan Statistics for AP GREEN PRYOR HEALTH AND WELFARE PLAN

401k plan membership statisitcs for AP GREEN PRYOR HEALTH AND WELFARE PLAN

Measure Date Value
2015: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 22
Number of retired or separated participants receiving benefits 2015-01-01 19
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 41
2014: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 22
Number of retired or separated participants receiving benefits 2014-01-01 18
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 40
2013: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 25
Number of retired or separated participants receiving benefits 2013-01-01 17
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 42
2012: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 23
Number of retired or separated participants receiving benefits 2012-01-01 15
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 38
2011: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 25
Number of retired or separated participants receiving benefits 2011-01-01 15
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 40
2010: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 24
Number of retired or separated participants receiving benefits 2010-01-01 14
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 38
2009: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 25
Number of retired or separated participants receiving benefits 2009-01-01 13
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 38

Measure	Date	Value
2015: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	22
Number of retired or separated participants receiving benefits	2015-01-01	19
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	41
2014: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	22
Number of retired or separated participants receiving benefits	2014-01-01	18
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	40
2013: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	25
Number of retired or separated participants receiving benefits	2013-01-01	17
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	42
2012: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	23
Number of retired or separated participants receiving benefits	2012-01-01	15
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	38
2011: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	25
Number of retired or separated participants receiving benefits	2011-01-01	15
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	40
2010: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	24
Number of retired or separated participants receiving benefits	2010-01-01	14
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	38
2009: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	25
Number of retired or separated participants receiving benefits	2009-01-01	13
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	38

Form 5500 Responses for AP GREEN PRYOR HEALTH AND WELFARE PLAN

2015: AP GREEN PRYOR HEALTH AND WELFARE 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	Yes
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: AP GREEN PRYOR HEALTH AND WELFARE 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	Yes
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: AP GREEN PRYOR HEALTH AND WELFARE 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	Yes
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: AP GREEN PRYOR HEALTH AND WELFARE 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	Yes
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: AP GREEN PRYOR HEALTH AND WELFARE 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	Yes
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
2010: AP GREEN PRYOR HEALTH AND WELFARE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: AP GREEN PRYOR HEALTH AND WELFARE PLAN 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	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388002530601
Policy instance	1
HIGHMARK CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 35599 )
Policy contract number	990087 0010
Policy instance	2
HIGHMARK CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 35599 )
Policy contract number	990087 0020
Policy instance	3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388002530601
Policy instance	1
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388002530601
Policy instance	1
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388002530601
Policy instance	1
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388002530601
Policy instance	1
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388002530601
Policy instance	1

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Company Name:	HARBISONWALKER INTERNATIONAL, INC.
Employer identification number (EIN):	431680037
NAIC Classification:	327100