401k Plan data: A-1 FIBERGLASS EMPLOYEE LIFE PLAN plan

A-1 FIBERGLASS EMPLOYEE LIFE PLAN 401k Plan overview

Plan Name	A-1 FIBERGLASS EMPLOYEE LIFE PLAN
Plan identification number	503

A-1 FIBERGLASS EMPLOYEE LIFE PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Life insurance
Death benefits (include travel accident but not life insurance)
Other welfare benefit cover
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.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

A-1 FIBERGLASS has sponsored the creation of one or more 401k plans.

Company Name: A-1 FIBERGLASS

Employer identification number (EIN): 470776618

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan A-1 FIBERGLASS EMPLOYEE LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2016-01-01 JOHN STILLEY
503 2015-01-01 JOHN STILLEY
503 2014-01-01 JOHN STILLEY
503 2011-01-01 JOHN STILLEY
503 2010-01-01 SUSAN TOURNOR
503 2009-01-01 SUSAN TOURNOR

Plan id#	Filing Submission Date	Name of Administrator
503	2016-01-01	JOHN STILLEY
503	2015-01-01	JOHN STILLEY
503	2014-01-01	JOHN STILLEY
503	2011-01-01	JOHN STILLEY
503	2010-01-01	SUSAN TOURNOR
503	2009-01-01	SUSAN TOURNOR

Plan Statistics for A-1 FIBERGLASS EMPLOYEE LIFE PLAN

401k plan membership statisitcs for A-1 FIBERGLASS EMPLOYEE LIFE PLAN

Measure Date Value
2016: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
2015: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 113
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 2015-01-01 113
2014: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 133
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 2014-01-01 133
2011: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 157
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 127
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 2011-01-01 127
2010: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 157
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 157
Number of participants with account balances 2010-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
Number of employers contributing to the scheme 2010-01-01 0
2009: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 167
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 91
Total of all active and inactive participants 2009-01-01 91
Total participants 2009-01-01 91

Measure	Date	Value
2016: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
2015: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	113
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	113
2014: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	133
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	133
2011: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	157
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	127
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	127
2010: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	157
Number of retired or separated participants receiving benefits	2010-01-01	0
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	157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	157
Number of participants with account balances	2010-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
Number of employers contributing to the scheme	2010-01-01	0
2009: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	167
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	91
Total of all active and inactive participants	2009-01-01	91
Total participants	2009-01-01	91

Form 5500 Responses for A-1 FIBERGLASS EMPLOYEE LIFE PLAN

2016: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: A-1 FIBERGLASS EMPLOYEE LIFE 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 benefit arrangement – Insurance	Yes
2014: A-1 FIBERGLASS EMPLOYEE LIFE 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 benefit arrangement – Insurance	Yes
2011: A-1 FIBERGLASS EMPLOYEE LIFE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
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 benefit arrangement – Insurance	Yes
2010: A-1 FIBERGLASS EMPLOYEE LIFE 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	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: A-1 FIBERGLASS EMPLOYEE LIFE 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	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F009912

Policy instance

Insurance contract or identification number	F009912
Number of Individuals Covered	127
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $707
Total amount of fees paid to insurance company	USD $94
Are there contracts with allocated funds for individual policies?	0
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	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 $4,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $707
Insurance broker organization code?	3
Amount paid for insurance broker fees	94
Additional information about fees paid to insurance broker	FEES
Insurance broker name	BLUE CROSS BLUE SHIELD OF NEBRASKA

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Company Name:	A-1 FIBERGLASS
Employer identification number (EIN):	470776618
NAIC Classification:	339900