401k Plan data: CAR-FRESHNER CORPORATION GROUP HEALTH PLAN plan

CAR-FRESHNER CORPORATION GROUP HEALTH PLAN 401k Plan overview

Plan Name	CAR-FRESHNER CORPORATION GROUP HEALTH PLAN
Plan identification number	503

CAR-FRESHNER CORPORATION GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

CAR-FRESHNER CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: CAR-FRESHNER CORPORATION

Employer identification number (EIN): 800550834

NAIC Classification: 323100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAR-FRESHNER CORPORATION GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-07-01 CHRISTINE ALTERI CHRISTINE ALTERI 2017-04-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2015-07-01	CHRISTINE ALTERI		CHRISTINE ALTERI	2017-04-12

Plan Statistics for CAR-FRESHNER CORPORATION GROUP HEALTH PLAN

401k plan membership statisitcs for CAR-FRESHNER CORPORATION GROUP HEALTH PLAN

Measure Date Value
2015: CAR-FRESHNER CORPORATION GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 363
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 358
Number of retired or separated participants receiving benefits 2015-07-01 8
Total of all active and inactive participants 2015-07-01 366
Total participants 2015-07-01 366

Measure	Date	Value
2015: CAR-FRESHNER CORPORATION GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	363
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	358
Number of retired or separated participants receiving benefits	2015-07-01	8
Total of all active and inactive participants	2015-07-01	366
Total participants	2015-07-01	366

Form 5500 Responses for CAR-FRESHNER CORPORATION GROUP HEALTH PLAN

2015: CAR-FRESHNER CORPORATION GROUP HEALTH 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 – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

HCL30559

Policy instance

Insurance contract or identification number	HCL30559
Number of Individuals Covered	330
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
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	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 $121,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

818340

Policy instance

Insurance contract or identification number	818340
Number of Individuals Covered	569
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
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	Yes
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 $129,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CAR-FRESHNER CORPORATION
Employer identification number (EIN):	800550834
NAIC Classification:	323100