401k Plan data: EMPLOYEE INJURY BENEFIT PLAN plan

EMPLOYEE INJURY BENEFIT PLAN 401k Plan overview

Plan Name	EMPLOYEE INJURY BENEFIT PLAN
Plan identification number	501

EMPLOYEE INJURY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

VICTORY PARENT COMPANY, LLC has sponsored the creation of one or more 401k plans.

Company Name: VICTORY PARENT COMPANY, LLC

Employer identification number (EIN): 451803191

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about VICTORY PARENT COMPANY, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2011-02-28

Company Identification Number: 0801391608

Legal Registered Office Address: 6608 EMERALD DR

COLLEYVILLE
United States of America (USA)
76034

More information about VICTORY PARENT COMPANY, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE INJURY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-07-01 ROBERT N.HELMS ROBERT N.HELMS 2016-01-29
501 2014-06-01 ROBERT HELMS JR
501 2013-07-01 WENDY GRONO WENDY GRONO 2015-02-11
501 2013-06-01 WENDY GRONO
501 2012-07-01 WENDY GRONO WENDY GRONO 2015-02-11
501 2012-06-01 WENDY GRONO
501 2011-07-01 WENDY GRONO WENDY GRONO 2013-10-02

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2014-07-01	ROBERT N.HELMS	ROBERT N.HELMS	2016-01-29
501	2014-06-01	ROBERT HELMS JR
501	2013-07-01	WENDY GRONO	WENDY GRONO	2015-02-11
501	2013-06-01	WENDY GRONO
501	2012-07-01	WENDY GRONO	WENDY GRONO	2015-02-11
501	2012-06-01	WENDY GRONO
501	2011-07-01	WENDY GRONO	WENDY GRONO	2013-10-02

Plan Statistics for EMPLOYEE INJURY BENEFIT PLAN

401k plan membership statisitcs for EMPLOYEE INJURY BENEFIT PLAN

Measure Date Value
2014: EMPLOYEE INJURY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 884
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 414
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 2014-07-01 414
Total participants, beginning-of-year 2014-06-01 539
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 481
Number of retired or separated participants receiving benefits 2014-06-01 0
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 481
2013: EMPLOYEE INJURY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 1,012
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 884
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 884
Total participants, beginning-of-year 2013-06-01 367
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 539
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 539
2012: EMPLOYEE INJURY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 741
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 1,012
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 1,012
Total participants, beginning-of-year 2012-06-01 135
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 366
Number of retired or separated participants receiving benefits 2012-06-01 1
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 367
2011: EMPLOYEE INJURY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 124
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 741
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 741

Measure	Date	Value
2014: EMPLOYEE INJURY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	884
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	414
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	414
Total participants, beginning-of-year	2014-06-01	539
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	481
Number of retired or separated participants receiving benefits	2014-06-01	0
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	481
2013: EMPLOYEE INJURY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	1,012
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	884
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	884
Total participants, beginning-of-year	2013-06-01	367
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	539
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	539
2012: EMPLOYEE INJURY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	741
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	1,012
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	1,012
Total participants, beginning-of-year	2012-06-01	135
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	366
Number of retired or separated participants receiving benefits	2012-06-01	1
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	367
2011: EMPLOYEE INJURY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	124
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	741
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	741

Form 5500 Responses for EMPLOYEE INJURY BENEFIT PLAN

2014: EMPLOYEE INJURY BENEFIT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
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 – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	No
2014-06-01	This submission is the final filing	No
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: EMPLOYEE INJURY BENEFIT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Submission has been amended	No
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: EMPLOYEE INJURY BENEFIT PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	Yes
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	First time form 5500 has been submitted	Yes
2012-06-01	Submission has been amended	No
2012-06-01	This submission is the final filing	No
2012-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-06-01	Plan is a collectively bargained plan	No
2012-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: EMPLOYEE INJURY BENEFIT PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	First time form 5500 has been submitted	Yes
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

147270

Policy instance

Insurance contract or identification number	147270
Number of Individuals Covered	101
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
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	Yes
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 $1,150,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	VICTORY PARENT COMPANY, LLC
Employer identification number (EIN):	451803191
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2011-02-28
Company Identification Number:	0801391608
Legal Registered Office Address:	6608 EMERALD DR COLLEYVILLE United States of America (USA) 76034