401k Plan data: SMART-FILL LIFE & DISABILITY PLAN plan

SMART-FILL LIFE & DISABILITY PLAN 401k Plan overview

Plan Name	SMART-FILL LIFE & DISABILITY PLAN
Plan identification number	501

SMART-FILL LIFE & DISABILITY PLAN Benefits

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

401k Sponsoring company profile

SMART-FILL EMPLOYER RESOURCES, INC. has sponsored the creation of one or more 401k plans.

Company Name: SMART-FILL EMPLOYER RESOURCES, INC.

Employer identification number (EIN): 455576749

NAIC Classification: 541214
NAIC Description: Payroll Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SMART-FILL LIFE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 RANDY SHINDELAR
501 2014-02-01 RANDY SHINDELAR RANDY SHINDELAR 2015-07-23
501 2013-02-01 RANDY SHINDELAR RANDY SHINDELAR 2014-07-28

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	RANDY SHINDELAR
501	2014-02-01	RANDY SHINDELAR	RANDY SHINDELAR	2015-07-23
501	2013-02-01	RANDY SHINDELAR	RANDY SHINDELAR	2014-07-28

Plan Statistics for SMART-FILL LIFE & DISABILITY PLAN

401k plan membership statisitcs for SMART-FILL LIFE & DISABILITY PLAN

Measure Date Value
2015: SMART-FILL LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 229
Total of all active and inactive participants 2015-01-01 229
2014: SMART-FILL LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-02-01 240
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 227
Total of all active and inactive participants 2014-02-01 227
2013: SMART-FILL LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-02-01 179
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 240
Total of all active and inactive participants 2013-02-01 240

Measure	Date	Value
2015: SMART-FILL LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	229
Total of all active and inactive participants	2015-01-01	229
2014: SMART-FILL LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-02-01	240
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	227
Total of all active and inactive participants	2014-02-01	227
2013: SMART-FILL LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-02-01	179
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	240
Total of all active and inactive participants	2013-02-01	240

Form 5500 Responses for SMART-FILL LIFE & DISABILITY PLAN

2015: SMART-FILL LIFE & DISABILITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple 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: SMART-FILL LIFE & DISABILITY PLAN 2014 form 5500 responses
2014-02-01	Type of plan entity	Mulitple employer plan
2014-02-01	Submission has been amended	No
2014-02-01	This submission is the final filing	No
2014-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-02-01	Plan is a collectively bargained plan	No
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes
2013: SMART-FILL LIFE & DISABILITY PLAN 2013 form 5500 responses
2013-02-01	Type of plan entity	Mulitple employer plan
2013-02-01	First time form 5500 has been submitted	Yes
2013-02-01	Submission has been amended	No
2013-02-01	This submission is the final filing	No
2013-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-02-01	Plan is a collectively bargained plan	No
2013-02-01	Plan funding arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

216929

Policy instance

Insurance contract or identification number	216929
Number of Individuals Covered	229
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $15,127
Total amount of fees paid to insurance company	USD $2,834
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD & D
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 $141,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,127
Amount paid for insurance broker fees	2834
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HAYS BENEFITS GROUP LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

216929

Policy instance

Insurance contract or identification number	216929
Number of Individuals Covered	227
Insurance policy start date	2014-02-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $12,661
Total amount of fees paid to insurance company	USD $2,822
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD & D
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 $126,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,661
Amount paid for insurance broker fees	2822
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HAYS BENEFITS GROUP LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

216929

Policy instance

Insurance contract or identification number	216929
Number of Individuals Covered	240
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Total amount of commissions paid to insurance broker	USD $10,919
Total amount of fees paid to insurance company	USD $5,459
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	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $119,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,919
Amount paid for insurance broker fees	5459
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HAYS BENEFITS GROUP LLC

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Company Name:	SMART-FILL EMPLOYER RESOURCES, INC.
Employer identification number (EIN):	455576749
NAIC Classification:	541214
NAIC Description:	Payroll Services