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| Plan Name | SCREEN-IT GRAPHICS OF LAWRENCE, INC. LIFE AND AD&D INSURANCE PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SCREEN-IT GRAPHICS OF LAWRENCE, |
| Employer identification number (EIN): | 481053811 |
| NAIC Classification: | 323100 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2017-03-01 | BRANDON PETZ |
| 2017: SCREEN-IT GRAPHICS OF LAWRENCE, INC. LIFE AND AD&D INSURANCE PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | First time form 5500 has been submitted | Yes |
| 2017-03-01 | Plan funding arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 648825 |
| Policy instance | 1 |
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