401k Plan data: HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN plan

HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN 401k Plan overview

Plan Name	HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN
Plan identification number	502

HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN Benefits

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

HORIZON MUD CO., INC. has sponsored the creation of one or more 401k plans.

Company Name: HORIZON MUD CO., INC.

Employer identification number (EIN): 751743577

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-07-01 LUKE BLACKWELL
502 2014-07-01 LUKE BLACKWELL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2015-07-01	LUKE BLACKWELL
502	2014-07-01	LUKE BLACKWELL

Plan Statistics for HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN

401k plan membership statisitcs for HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN

Measure Date Value
2015: HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 114
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 40
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 40
2014: HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 184
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 114
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 114

Measure	Date	Value
2015: HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	114
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	40
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	40
2014: HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	184
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	114
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	114

Form 5500 Responses for HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN

2015: HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: HORIZON MUD COMPANY, INC. LIFE, DENTAL AND AD&D PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	First time form 5500 has been submitted	Yes
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	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

1054698

Policy instance

Insurance contract or identification number	1054698
Number of Individuals Covered	146
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $6,402
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	No
Dental Insurance Welfare Benefit	Yes
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
Other welfare benefits provided	AD&D
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 $67,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,201
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	DENNIS R GREENSAGE

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FG1D2064

Policy instance

Insurance contract or identification number	FG1D2064
Number of Individuals Covered	95
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $17,582
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	No
Dental Insurance Welfare Benefit	Yes
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
Other welfare benefits provided	AD&D
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 $165,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,791
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	DENNIS R GREENSAGE

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Company Name:	HORIZON MUD CO., INC.
Employer identification number (EIN):	751743577
NAIC Classification:	238900