401k Plan data: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN plan

ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 401k Plan overview

Plan Name	ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN
Plan identification number	524

ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

ZENITH AMERICAN SOLUTIONS, INC has sponsored the creation of one or more 401k plans.

Company Name: ZENITH AMERICAN SOLUTIONS, INC

Employer identification number (EIN): 521590516

NAIC Classification: 524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
524 2015-01-01 JOANN M KAMINSKI
524 2015-01-01 PATRICIA OSTROWSKI
524 2014-01-01 JOANNE M KAMINSIU
524 2013-08-01 JOANN M KAMINSKI
524 2012-08-01 JOANN M KAMINSKI
524 2011-08-01 JOANN M. KAMINSKI

Plan id#	Filing Submission Date	Name of Administrator
524	2015-01-01	JOANN M KAMINSKI
524	2015-01-01	PATRICIA OSTROWSKI
524	2014-01-01	JOANNE M KAMINSIU
524	2013-08-01	JOANN M KAMINSKI
524	2012-08-01	JOANN M KAMINSKI
524	2011-08-01	JOANN M. KAMINSKI

Plan Statistics for ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN

401k plan membership statisitcs for ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN

Measure Date Value
2015: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 222
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 225
2014: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2,368
Number of retired or separated participants receiving benefits 2014-01-01 1
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 2,369
2013: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-08-01 281
Total number of active participants reported on line 7a of the Form 5500 2013-08-01 247
Number of retired or separated participants receiving benefits 2013-08-01 0
Number of other retired or separated participants entitled to future benefits 2013-08-01 0
Total of all active and inactive participants 2013-08-01 247
2012: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-08-01 398
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 281
Number of retired or separated participants receiving benefits 2012-08-01 0
Number of other retired or separated participants entitled to future benefits 2012-08-01 0
Total of all active and inactive participants 2012-08-01 281
2011: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-08-01 398
Total number of active participants reported on line 7a of the Form 5500 2011-08-01 398
Number of retired or separated participants receiving benefits 2011-08-01 0
Number of other retired or separated participants entitled to future benefits 2011-08-01 0
Total of all active and inactive participants 2011-08-01 398

Measure	Date	Value
2015: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	222
Number of retired or separated participants receiving benefits	2015-01-01	3
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	225
2014: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,368
Number of retired or separated participants receiving benefits	2014-01-01	1
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	2,369
2013: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-08-01	281
Total number of active participants reported on line 7a of the Form 5500	2013-08-01	247
Number of retired or separated participants receiving benefits	2013-08-01	0
Number of other retired or separated participants entitled to future benefits	2013-08-01	0
Total of all active and inactive participants	2013-08-01	247
2012: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-08-01	398
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	281
Number of retired or separated participants receiving benefits	2012-08-01	0
Number of other retired or separated participants entitled to future benefits	2012-08-01	0
Total of all active and inactive participants	2012-08-01	281
2011: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-08-01	398
Total number of active participants reported on line 7a of the Form 5500	2011-08-01	398
Number of retired or separated participants receiving benefits	2011-08-01	0
Number of other retired or separated participants entitled to future benefits	2011-08-01	0
Total of all active and inactive participants	2011-08-01	398

Form 5500 Responses for ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN

2015: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT 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: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT 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
2013: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-08-01	Type of plan entity	Single employer plan
2013-08-01	Submission has been amended	No
2013-08-01	This submission is the final filing	No
2013-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-08-01	Plan is a collectively bargained plan	No
2013-08-01	Plan funding arrangement – Insurance	Yes
2013-08-01	Plan benefit arrangement – Insurance	Yes
2012: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Submission has been amended	No
2012-08-01	This submission is the final filing	No
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-08-01	Plan is a collectively bargained plan	No
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2011: ZENITH AMERICAN SOLUTIONS HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-08-01	Type of plan entity	Single employer plan
2011-08-01	First time form 5500 has been submitted	Yes
2011-08-01	Submission has been amended	No
2011-08-01	This submission is the final filing	No
2011-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-08-01	Plan is a collectively bargained plan	No
2011-08-01	Plan funding arrangement – Insurance	Yes
2011-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P38683

Policy instance

Insurance contract or identification number	P38683
Number of Individuals Covered	450
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $2,774,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P38683

Policy instance

Insurance contract or identification number	P38683
Number of Individuals Covered	472
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $25,202
Total amount of fees paid to insurance company	USD $0
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $2,578,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,202
Insurance broker organization code?	3
Insurance broker name	ZENITH AMERICAN SOLUTIONS, INC.

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P38683

Policy instance

Insurance contract or identification number	P38683
Number of Individuals Covered	580
Insurance policy start date	2013-08-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $13,172
Total amount of fees paid to insurance company	USD $42
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $1,310,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,172
Amount paid for insurance broker fees	28
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ZENITH AMERICAN SOLUTIONS, INC.

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P38683

Policy instance

Insurance contract or identification number	P38683
Number of Individuals Covered	660
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $30,389
Total amount of fees paid to insurance company	USD $17
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $3,039,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,389
Amount paid for insurance broker fees	12
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ZENITH AMERICAN SOLUTIONS, INC.

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3335012

Policy instance

Insurance contract or identification number	3335012
Number of Individuals Covered	398
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $48,574
Total amount of fees paid to insurance company	USD $0
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $309,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	ZENITH AMERICAN SOLUTIONS, INC
Employer identification number (EIN):	521590516
NAIC Classification:	524290