401k Plan data: WAGLY, INC. HEALTH AND WELFARE PLAN plan

WAGLY, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	WAGLY, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

WAGLY, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover 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

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

Company Name: WAGLY, INC.

Employer identification number (EIN): 473651948

NAIC Classification: 812910
NAIC Description: Pet Care (except Veterinary) Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WAGLY, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01

Plan Statistics for WAGLY, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for WAGLY, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2017: WAGLY, INC. HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 81
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 81

Measure	Date	Value
2017: WAGLY, INC. HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	81
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	81

Form 5500 Responses for WAGLY, INC. HEALTH AND WELFARE PLAN

2017: WAGLY, INC. HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

1058823

Policy instance

Insurance contract or identification number	1058823
Number of Individuals Covered	107
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,264
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $67,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,264
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

10020422

Policy instance

Insurance contract or identification number	10020422
Number of Individuals Covered	87
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $33,746
Total amount of fees paid to insurance company	USD $4,934
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $717,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,746
Amount paid for insurance broker fees	4934
Additional information about fees paid to insurance broker	BONUS NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30063532

Policy instance

Insurance contract or identification number	30063532
Number of Individuals Covered	71
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $559
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $559
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

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Company Name:	WAGLY, INC.
Employer identification number (EIN):	473651948
NAIC Classification:	812910
NAIC Description:	Pet Care (except Veterinary) Services