401k Plan data: GROUP LIFE/AD&D PLAN plan

GROUP LIFE/AD&D PLAN 401k Plan overview

Plan Name	GROUP LIFE/AD&D PLAN
Plan identification number	503

GROUP LIFE/AD&D PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance 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

NATIONAL QUALITY FORUM has sponsored the creation of one or more 401k plans.

Company Name: NATIONAL QUALITY FORUM

Employer identification number (EIN): 522175544

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about NATIONAL QUALITY FORUM

Jurisdiction of Incorporation: District of Columbia Corporations Division

Incorporation Date:

Company Identification Number: 991403

More information about NATIONAL QUALITY FORUM

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP LIFE/AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-12-01 EBONY CLARK
503 2012-04-01 EBONY J CLARK EBONY J CLARK 2013-06-24
503 2011-04-01 EBONY J CLARK EBONY J CLARK 2012-10-22
503 2010-04-01 EBONY CLARK

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2012-12-01	EBONY CLARK
503	2012-04-01	EBONY J CLARK	EBONY J CLARK	2013-06-24
503	2011-04-01	EBONY J CLARK	EBONY J CLARK	2012-10-22
503	2010-04-01	EBONY CLARK

Plan Statistics for GROUP LIFE/AD&D PLAN

401k plan membership statisitcs for GROUP LIFE/AD&D PLAN

Measure Date Value
2012: GROUP LIFE/AD&D PLAN 2012 401k membership
Total participants, beginning-of-year 2012-12-01 106
Total number of active participants reported on line 7a of the Form 5500 2012-12-01 91
Number of retired or separated participants receiving benefits 2012-12-01 0
Number of other retired or separated participants entitled to future benefits 2012-12-01 0
Total of all active and inactive participants 2012-12-01 91
Total participants, beginning-of-year 2012-04-01 118
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 106
Number of retired or separated participants receiving benefits 2012-04-01 0
Number of other retired or separated participants entitled to future benefits 2012-04-01 0
Total of all active and inactive participants 2012-04-01 106
2011: GROUP LIFE/AD&D PLAN 2011 401k membership
Total participants, beginning-of-year 2011-04-01 102
Total number of active participants reported on line 7a of the Form 5500 2011-04-01 118
Number of retired or separated participants receiving benefits 2011-04-01 0
Number of other retired or separated participants entitled to future benefits 2011-04-01 0
Total of all active and inactive participants 2011-04-01 118
2010: GROUP LIFE/AD&D PLAN 2010 401k membership
Total participants, beginning-of-year 2010-04-01 100
Total number of active participants reported on line 7a of the Form 5500 2010-04-01 102
Number of retired or separated participants receiving benefits 2010-04-01 0
Number of other retired or separated participants entitled to future benefits 2010-04-01 0
Total of all active and inactive participants 2010-04-01 102

Measure	Date	Value
2012: GROUP LIFE/AD&D PLAN 2012 401k membership
Total participants, beginning-of-year	2012-12-01	106
Total number of active participants reported on line 7a of the Form 5500	2012-12-01	91
Number of retired or separated participants receiving benefits	2012-12-01	0
Number of other retired or separated participants entitled to future benefits	2012-12-01	0
Total of all active and inactive participants	2012-12-01	91
Total participants, beginning-of-year	2012-04-01	118
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	106
Number of retired or separated participants receiving benefits	2012-04-01	0
Number of other retired or separated participants entitled to future benefits	2012-04-01	0
Total of all active and inactive participants	2012-04-01	106
2011: GROUP LIFE/AD&D PLAN 2011 401k membership
Total participants, beginning-of-year	2011-04-01	102
Total number of active participants reported on line 7a of the Form 5500	2011-04-01	118
Number of retired or separated participants receiving benefits	2011-04-01	0
Number of other retired or separated participants entitled to future benefits	2011-04-01	0
Total of all active and inactive participants	2011-04-01	118
2010: GROUP LIFE/AD&D PLAN 2010 401k membership
Total participants, beginning-of-year	2010-04-01	100
Total number of active participants reported on line 7a of the Form 5500	2010-04-01	102
Number of retired or separated participants receiving benefits	2010-04-01	0
Number of other retired or separated participants entitled to future benefits	2010-04-01	0
Total of all active and inactive participants	2010-04-01	102

Form 5500 Responses for GROUP LIFE/AD&D PLAN

2012: GROUP LIFE/AD&D PLAN 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Submission has been amended	No
2012-12-01	This submission is the final filing	No
2012-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-12-01	Plan is a collectively bargained plan	No
2012-12-01	Plan funding arrangement – Insurance	Yes
2012-12-01	Plan benefit arrangement – Insurance	Yes
2012-04-01	Type of plan entity	Single employer plan
2012-04-01	Submission has been amended	No
2012-04-01	This submission is the final filing	No
2012-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-04-01	Plan is a collectively bargained plan	No
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes
2011: GROUP LIFE/AD&D PLAN 2011 form 5500 responses
2011-04-01	Type of plan entity	Single employer plan
2011-04-01	Submission has been amended	No
2011-04-01	This submission is the final filing	No
2011-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-04-01	Plan is a collectively bargained plan	No
2011-04-01	Plan funding arrangement – Insurance	Yes
2011-04-01	Plan benefit arrangement – Insurance	Yes
2010: GROUP LIFE/AD&D PLAN 2010 form 5500 responses
2010-04-01	Type of plan entity	Single employer plan
2010-04-01	First time form 5500 has been submitted	Yes
2010-04-01	Submission has been amended	No
2010-04-01	This submission is the final filing	No
2010-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-04-01	Plan is a collectively bargained plan	No
2010-04-01	Plan funding arrangement – Insurance	Yes
2010-04-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	NATIONAL QUALITY FORUM
Employer identification number (EIN):	522175544
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	District of Columbia Corporations Division
Incorporation Date:
Company Identification Number:	991403