401k Plan data: MCLENDON HARDWARE DENTAL AND VISION PLAN plan

MCLENDON HARDWARE DENTAL AND VISION PLAN 401k Plan overview

Plan Name	MCLENDON HARDWARE DENTAL AND VISION PLAN
Plan identification number	752

MCLENDON HARDWARE DENTAL AND VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Vision

401k Sponsoring company profile

MCLENDON HARDWARE, INC. has sponsored the creation of one or more 401k plans.

Company Name: MCLENDON HARDWARE, INC.

Employer identification number (EIN): 910743973

NAIC Classification: 444130
NAIC Description: Hardware Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MCLENDON HARDWARE DENTAL AND VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
752 2017-01-01 GAIL MCLENDON GAIL MCLENDON 2018-07-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
752	2017-01-01	GAIL MCLENDON		GAIL MCLENDON	2018-07-23

Plan Statistics for MCLENDON HARDWARE DENTAL AND VISION PLAN

401k plan membership statisitcs for MCLENDON HARDWARE DENTAL AND VISION PLAN

Measure Date Value
2017: MCLENDON HARDWARE DENTAL AND VISION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 434
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Total participants 2017-01-01 0

Measure	Date	Value
2017: MCLENDON HARDWARE DENTAL AND VISION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	434
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Total participants	2017-01-01	0

Form 5500 Responses for MCLENDON HARDWARE DENTAL AND VISION PLAN

2017: MCLENDON HARDWARE DENTAL AND VISION 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	Yes
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

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05939660

Policy instance

Insurance contract or identification number	KM05939660
Number of Individuals Covered	521
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $12,269
Total amount of fees paid to insurance company	USD $1,466
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?	Yes
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	Yes
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 $70,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	GROUP DENTAL AND VISION
Commission paid to Insurance Broker	USD $12,269
Amount paid for insurance broker fees	1466
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES INC.

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Company Name:	MCLENDON HARDWARE, INC.
Employer identification number (EIN):	910743973
NAIC Classification:	444130
NAIC Description:	Hardware Stores