401k Plan data: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN plan

KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 401k Plan overview

Plan Name	KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN
Plan identification number	502

KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Other welfare benefit cover

401k Sponsoring company profile

KELLY CABLE COMPANY OF NEW MEX has sponsored the creation of one or more 401k plans.

Company Name: KELLY CABLE COMPANY OF NEW MEX

Employer identification number (EIN): 742481268

NAIC Classification: 237100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-10-01 ROGER PENNINGTON ROGER PENNINGTON 2018-07-19
502 2016-10-01 DJOKO BOENTARAN DJOKO BOENTARAN 2018-03-26
502 2015-10-01 DJOKO BOENTARAN DJOKO BOENTARAN 2017-11-14
502 2014-10-01 DJOKO BOENTARAN DJOKO BOENTARAN 2017-11-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2017-10-01	ROGER PENNINGTON	ROGER PENNINGTON	2018-07-19
502	2016-10-01	DJOKO BOENTARAN	DJOKO BOENTARAN	2018-03-26
502	2015-10-01	DJOKO BOENTARAN	DJOKO BOENTARAN	2017-11-14
502	2014-10-01	DJOKO BOENTARAN	DJOKO BOENTARAN	2017-11-14

Plan Statistics for KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN

401k plan membership statisitcs for KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN

Measure Date Value
2017: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 156
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 0
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 0
2016: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 133
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 156
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 156
2015: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 161
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 133
Number of retired or separated participants receiving benefits 2015-10-01 0
Number of other retired or separated participants entitled to future benefits 2015-10-01 0
Total of all active and inactive participants 2015-10-01 133
2014: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 158
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 161
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 161

Measure	Date	Value
2017: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	156
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	0
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	0
2016: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	133
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	156
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	156
2015: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	161
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	133
Number of retired or separated participants receiving benefits	2015-10-01	0
Number of other retired or separated participants entitled to future benefits	2015-10-01	0
Total of all active and inactive participants	2015-10-01	133
2014: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	158
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	161
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	161

Form 5500 Responses for KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN

2017: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	Yes
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: KELLY CABLE OF N.M., INC. GROUP LIFE INSURANCE PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	First time form 5500 has been submitted	Yes
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

238045

Policy instance

Insurance contract or identification number	238045
Number of Individuals Covered	162
Insurance policy start date	2017-10-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $507
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $393
Insurance broker organization code?	3
Insurance broker name	PAYCHEX INSURANCE AGENCY INC.

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Company Name:	KELLY CABLE COMPANY OF NEW MEX
Employer identification number (EIN):	742481268
NAIC Classification:	237100