401k Plan data: KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN plan

KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN 401k Plan overview

Plan Name	KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN
Plan identification number	504

KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN Benefits

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

401k Sponsoring company profile

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

Company Name: KINGSDOWN INC.

Employer identification number (EIN): 530319850

NAIC Classification: 337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2015-01-01 TIMOTHY PRICE TIMOTHY PRICE 2016-08-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2015-01-01	TIMOTHY PRICE		TIMOTHY PRICE	2016-08-29

Plan Statistics for KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN

401k plan membership statisitcs for KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN

Measure Date Value
2015: KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 269
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 237
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 2015-01-01 237
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 237
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
Number of employers contributing to the scheme 2015-01-01 0

Measure	Date	Value
2015: KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	269
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	237
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	237
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	237
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
Number of employers contributing to the scheme	2015-01-01	0

Form 5500 Responses for KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN

2015: KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
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 funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

418157

Policy instance

Insurance contract or identification number	418157
Number of Individuals Covered	260
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $11,162
Total amount of fees paid to insurance company	USD $1,649
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	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 $98,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,162
Insurance broker organization code?	3
Insurance broker name	BB&T INS SERVICE INC

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417002411133

Policy instance

Insurance contract or identification number	417002411133
Number of Individuals Covered	237
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
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	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 $199,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

KINGSDOWN INCORPORATED & AFFILIATES CAFETERIA PLAN [EIN = 560319850]

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Company Name:	KINGSDOWN INC.
Employer identification number (EIN):	530319850
NAIC Classification:	337000