401k Plan data: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN plan

W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 401k Plan overview

Plan Name	W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN
Plan identification number	502

W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

W.G. CLARK CONSTRUCTION CO. has sponsored the creation of one or more 401k plans.

Company Name: W.G. CLARK CONSTRUCTION CO.

Employer identification number (EIN): 910618025

NAIC Classification: 236200

Additional information about W.G. CLARK CONSTRUCTION CO.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1954-06-10

Company Identification Number: 578015994

Legal Registered Office Address: 10900 NE 4TH ST STE 1850

BELLEVUE
United States of America (USA)
980048341

More information about W.G. CLARK CONSTRUCTION CO.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01
502 2015-10-01 KEVIN PANTZAR KEVIN PANTZAR 2017-03-03
502 2014-10-01 KEVIN PANTZAR KEVIN PANTZAR 2016-03-18
502 2013-10-01 KEVIN PANTZAR KEVIN PANTZAR 2015-03-09
502 2008-07-01 KEVIN PANTZAR KEVIN PANTZAR 2011-04-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2017-01-01
502	2015-10-01	KEVIN PANTZAR	KEVIN PANTZAR	2017-03-03
502	2014-10-01	KEVIN PANTZAR	KEVIN PANTZAR	2016-03-18
502	2013-10-01	KEVIN PANTZAR	KEVIN PANTZAR	2015-03-09
502	2008-07-01	KEVIN PANTZAR	KEVIN PANTZAR	2011-04-15

Plan Statistics for W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN

401k plan membership statisitcs for W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN

Measure Date Value
2017: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 155
Total of all active and inactive participants 2017-01-01 155
Total participants 2017-01-01 155
2015: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 136
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 142
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 2015-10-01 142
2014: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 125
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 136
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 2014-10-01 136
2013: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 124
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 125
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 0
Total of all active and inactive participants 2013-10-01 125
2008: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2008 401k membership
Total participants, beginning-of-year 2008-07-01 129
Total number of active participants reported on line 7a of the Form 5500 2008-07-01 122
Number of retired or separated participants receiving benefits 2008-07-01 0
Number of other retired or separated participants entitled to future benefits 2008-07-01 0
Total of all active and inactive participants 2008-07-01 122
Total participants 2008-07-01 0

Measure	Date	Value
2017: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	155
Total of all active and inactive participants	2017-01-01	155
Total participants	2017-01-01	155
2015: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	136
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	142
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	142
2014: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	125
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	136
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	136
2013: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	124
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	125
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	0
Total of all active and inactive participants	2013-10-01	125
2008: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2008 401k membership
Total participants, beginning-of-year	2008-07-01	129
Total number of active participants reported on line 7a of the Form 5500	2008-07-01	122
Number of retired or separated participants receiving benefits	2008-07-01	0
Number of other retired or separated participants entitled to future benefits	2008-07-01	0
Total of all active and inactive participants	2008-07-01	122
Total participants	2008-07-01	0

Form 5500 Responses for W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN

2017: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2015: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY 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: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
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
2013: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2008: W.G. CLARK CONSTRUCTION CO. LONG-TERM DISABILITY PLAN 2008 form 5500 responses
2008-07-01	Type of plan entity	Single employer plan
2008-07-01	First time form 5500 has been submitted	Yes
2008-07-01	Submission has been amended	No
2008-07-01	This submission is the final filing	No
2008-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-07-01	Plan is a collectively bargained plan	No
2008-07-01	Plan funding arrangement – Insurance	Yes
2008-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

700117

Policy instance

Insurance contract or identification number	700117
Number of Individuals Covered	155
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,274
Total amount of fees paid to insurance company	USD $271
Are there contracts with allocated funds for individual policies?	0
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	Yes
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 $31,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,274
Amount paid for insurance broker fees	271
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BRATRUD MIDDLETON INSURANCE BROKER

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

Policy contract number

700117

Policy instance

Insurance contract or identification number	700117
Number of Individuals Covered	142
Insurance policy start date	2015-10-01
Insurance policy end date	2016-09-30
Total amount of commissions paid to insurance broker	USD $3,451
Total amount of fees paid to insurance company	USD $218
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,451
Amount paid for insurance broker fees	218
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	BRATRUD MIDDLETON INSURANCE BROKER

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

Policy contract number

700117

Policy instance

Insurance contract or identification number	700117
Number of Individuals Covered	136
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,608
Total amount of fees paid to insurance company	USD $523
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,608
Amount paid for insurance broker fees	523
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	BRATRUD MIDDLETON INSURANCE BROKER

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

Policy contract number

215428

Policy instance

Insurance contract or identification number	215428
Number of Individuals Covered	125
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $4,316
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,316
Insurance broker organization code?	3
Are there contracts with allocated funds for individual policies?	0
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
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
Insurance broker name	BRATRUD MIDDLETON INSURANCE BROKERS

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMTD07R86

Policy instance

Insurance contract or identification number	GMTD07R86
Number of Individuals Covered	107
Insurance policy start date	2009-07-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $4,043
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,043
Insurance broker organization code?	3
Insurance broker name	CAPITAL BENEFIT SERVICES

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMTD 07R86

Policy instance

Insurance contract or identification number	GMTD 07R86
Number of Individuals Covered	122
Insurance policy start date	2008-07-01
Insurance policy end date	2009-06-30
Total amount of commissions paid to insurance broker	USD $4,261
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,261
Insurance broker organization code?	3
Insurance broker name	CAPITAL BENEFIT SERVICES

Potentially related plans

W.G. CLARK, C.P.A. PROFIT SHARING PLAN [EIN = 382715313]

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Company Name:	W.G. CLARK CONSTRUCTION CO.
Employer identification number (EIN):	910618025
NAIC Classification:	236200

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1954-06-10
Company Identification Number:	578015994
Legal Registered Office Address:	10900 NE 4TH ST STE 1850 BELLEVUE United States of America (USA) 980048341