401k Plan data: TEAM CHARTER SCHOOL BENEFITS PLAN plan

TEAM CHARTER SCHOOL BENEFITS PLAN 401k Plan overview

Plan Name	TEAM CHARTER SCHOOL BENEFITS PLAN
Plan identification number	501

TEAM CHARTER SCHOOL BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Other welfare benefit cover

401k Sponsoring company profile

TEAM ACADEMY CHARTER SCHOOL, INC. has sponsored the creation of one or more 401k plans.

Company Name: TEAM ACADEMY CHARTER SCHOOL, INC.

Employer identification number (EIN): 010660264

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TEAM CHARTER SCHOOL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2013-07-01 TERRY BROWN TERRY BROWN 2018-01-02
501 2012-07-01 TERRY BROWN TERRY BROWN 2018-01-02
501 2011-07-01 TERRY BROWN TERRY BROWN 2018-01-02

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2013-07-01	TERRY BROWN	TERRY BROWN	2018-01-02
501	2012-07-01	TERRY BROWN	TERRY BROWN	2018-01-02
501	2011-07-01	TERRY BROWN	TERRY BROWN	2018-01-02

Plan Statistics for TEAM CHARTER SCHOOL BENEFITS PLAN

401k plan membership statisitcs for TEAM CHARTER SCHOOL BENEFITS PLAN

Measure Date Value
2013: TEAM CHARTER SCHOOL BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 434
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 518
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 2013-07-01 518
Total participants 2013-07-01 518
2012: TEAM CHARTER SCHOOL BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 357
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 434
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 2012-07-01 434
Total participants 2012-07-01 434
2011: TEAM CHARTER SCHOOL BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 279
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 357
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 2011-07-01 357
Total participants 2011-07-01 357

Measure	Date	Value
2013: TEAM CHARTER SCHOOL BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	434
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	518
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	518
Total participants	2013-07-01	518
2012: TEAM CHARTER SCHOOL BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	357
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	434
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	434
Total participants	2012-07-01	434
2011: TEAM CHARTER SCHOOL BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	279
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	357
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	357
Total participants	2011-07-01	357

Form 5500 Responses for TEAM CHARTER SCHOOL BENEFITS PLAN

2013: TEAM CHARTER SCHOOL BENEFITS 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 – Insurance	Yes
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: TEAM CHARTER SCHOOL BENEFITS PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
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 – Insurance	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: TEAM CHARTER SCHOOL BENEFITS 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 – Insurance	Yes
2011-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

848021

Policy instance

Insurance contract or identification number	848021
Number of Individuals Covered	481
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $87,220
Total amount of fees paid to insurance company	USD $692
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	Yes
Dental Insurance Welfare Benefit	Yes
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 $2,153,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $87,220
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING INC.

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

848021

Policy instance

Insurance contract or identification number	848021
Number of Individuals Covered	381
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $18,021
Total amount of fees paid to insurance company	USD $692
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	Yes
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 $1,600,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,648
Insurance broker organization code?	3
Amount paid for insurance broker fees	692
Additional information about fees paid to insurance broker	PM CROSS-SALE
Insurance broker name	O'GORMAN & YOUNG INC.

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3330434

Policy instance

Insurance contract or identification number	3330434
Number of Individuals Covered	195
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $81,753
Total amount of fees paid to insurance company	USD $0
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	Yes
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
Other welfare benefits provided	PREPAID DENTAL
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 $1,763,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,753
Insurance broker organization code?	3
Insurance broker name	O'GORMAN & YOUNG INC.

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Company Name:	TEAM ACADEMY CHARTER SCHOOL, INC.
Employer identification number (EIN):	010660264
NAIC Classification:	611000