401k Plan data: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN plan

THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 401k Plan overview

Plan Name	THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN
Plan identification number	501

THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

REFORMED CHURCH IN AMERICA has sponsored the creation of one or more 401k plans.

Company Name: REFORMED CHURCH IN AMERICA

Employer identification number (EIN): 135562285

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2013-10-01 JILLISA TEITSMA
501 2012-10-01 RHONDA LIGHTCAP
501 2011-10-01 RHONDA LIGHTCAP
501 2010-10-01 RHONDA LIGHTCAP
501 2009-10-01 RHONDA LIGHTCAP
501 2008-10-01 KENNETH R. BRADSELL
501 2007-10-01 KENNETH R. BRADSELL
501 2006-10-01 KENNETH R. BRADSELL
501 2005-10-01 KENNETH R. BRADSELL
501 2004-10-01 KENNETH R. BRADSELL

Plan id#	Filing Submission Date	Name of Administrator
501	2013-10-01	JILLISA TEITSMA
501	2012-10-01	RHONDA LIGHTCAP
501	2011-10-01	RHONDA LIGHTCAP
501	2010-10-01	RHONDA LIGHTCAP
501	2009-10-01	RHONDA LIGHTCAP
501	2008-10-01	KENNETH R. BRADSELL
501	2007-10-01	KENNETH R. BRADSELL
501	2006-10-01	KENNETH R. BRADSELL
501	2005-10-01	KENNETH R. BRADSELL
501	2004-10-01	KENNETH R. BRADSELL

Plan Statistics for THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN

401k plan membership statisitcs for THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN

Measure Date Value
2013: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 1,006
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 0
Total of all active and inactive participants 2013-10-01 0
2012: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 1,017
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 1,002
Number of retired or separated participants receiving benefits 2012-10-01 4
Total of all active and inactive participants 2012-10-01 1,006
2011: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 1,051
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 1,016
Number of retired or separated participants receiving benefits 2011-10-01 1
Total of all active and inactive participants 2011-10-01 1,017
2010: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-10-01 1,040
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 1,051
Total of all active and inactive participants 2010-10-01 1,051
2009: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 1,420
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 1,033
Number of retired or separated participants receiving benefits 2009-10-01 320
Total of all active and inactive participants 2009-10-01 1,353
2008: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year 2008-10-01 1,475
Total number of active participants reported on line 7a of the Form 5500 2008-10-01 1,061
Number of retired or separated participants receiving benefits 2008-10-01 359
Total of all active and inactive participants 2008-10-01 1,420
2007: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year 2007-10-01 1,513
Total number of active participants reported on line 7a of the Form 5500 2007-10-01 1,106
Number of retired or separated participants receiving benefits 2007-10-01 369
Total of all active and inactive participants 2007-10-01 1,475
2006: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year 2006-10-01 1,401
Total number of active participants reported on line 7a of the Form 5500 2006-10-01 1,113
Number of retired or separated participants receiving benefits 2006-10-01 400
Total of all active and inactive participants 2006-10-01 1,513
2005: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year 2005-10-01 1,448
Total number of active participants reported on line 7a of the Form 5500 2005-10-01 1,014
Number of retired or separated participants receiving benefits 2005-10-01 387
Total of all active and inactive participants 2005-10-01 1,401
2004: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year 2004-10-01 1,350
Total number of active participants reported on line 7a of the Form 5500 2004-10-01 990
Number of retired or separated participants receiving benefits 2004-10-01 458
Total of all active and inactive participants 2004-10-01 1,448

Measure	Date	Value
2013: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	1,006
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	0
Total of all active and inactive participants	2013-10-01	0
2012: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	1,017
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	1,002
Number of retired or separated participants receiving benefits	2012-10-01	4
Total of all active and inactive participants	2012-10-01	1,006
2011: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	1,051
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	1,016
Number of retired or separated participants receiving benefits	2011-10-01	1
Total of all active and inactive participants	2011-10-01	1,017
2010: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-10-01	1,040
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	1,051
Total of all active and inactive participants	2010-10-01	1,051
2009: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	1,420
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	1,033
Number of retired or separated participants receiving benefits	2009-10-01	320
Total of all active and inactive participants	2009-10-01	1,353
2008: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year	2008-10-01	1,475
Total number of active participants reported on line 7a of the Form 5500	2008-10-01	1,061
Number of retired or separated participants receiving benefits	2008-10-01	359
Total of all active and inactive participants	2008-10-01	1,420
2007: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year	2007-10-01	1,513
Total number of active participants reported on line 7a of the Form 5500	2007-10-01	1,106
Number of retired or separated participants receiving benefits	2007-10-01	369
Total of all active and inactive participants	2007-10-01	1,475
2006: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year	2006-10-01	1,401
Total number of active participants reported on line 7a of the Form 5500	2006-10-01	1,113
Number of retired or separated participants receiving benefits	2006-10-01	400
Total of all active and inactive participants	2006-10-01	1,513
2005: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year	2005-10-01	1,448
Total number of active participants reported on line 7a of the Form 5500	2005-10-01	1,014
Number of retired or separated participants receiving benefits	2005-10-01	387
Total of all active and inactive participants	2005-10-01	1,401
2004: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year	2004-10-01	1,350
Total number of active participants reported on line 7a of the Form 5500	2004-10-01	990
Number of retired or separated participants receiving benefits	2004-10-01	458
Total of all active and inactive participants	2004-10-01	1,448

Form 5500 Responses for THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN

2013: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	This submission is the final filing	Yes
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Plan funding arrangement – Insurance	Yes
2010-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-10-01	Plan benefit arrangement – Insurance	Yes
2010-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	This submission is the final filing	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2008: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Submission has been amended	Yes
2008-10-01	Plan funding arrangement – Insurance	Yes
2008-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-10-01	Plan benefit arrangement – Insurance	Yes
2008-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2007 form 5500 responses
2007-10-01	Type of plan entity	Single employer plan
2007-10-01	Submission has been amended	Yes
2007-10-01	Plan funding arrangement – Insurance	Yes
2007-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-10-01	Plan benefit arrangement – Insurance	Yes
2007-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2006: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2006 form 5500 responses
2006-10-01	Type of plan entity	Single employer plan
2006-10-01	Submission has been amended	Yes
2006-10-01	Plan funding arrangement – Insurance	Yes
2006-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-10-01	Plan benefit arrangement – Insurance	Yes
2006-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2005: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2005 form 5500 responses
2005-10-01	Type of plan entity	Single employer plan
2005-10-01	Submission has been amended	Yes
2005-10-01	Plan funding arrangement – Insurance	Yes
2005-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2005-10-01	Plan benefit arrangement – Insurance	Yes
2005-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2004: THE REFORMED CHURCH IN AMERICA HEALTH BENEFIT PLAN 2004 form 5500 responses
2004-10-01	Type of plan entity	Single employer plan
2004-10-01	Submission has been amended	Yes
2004-10-01	Plan funding arrangement – Insurance	Yes
2004-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2004-10-01	Plan benefit arrangement – Insurance	Yes
2004-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	REFORMED CHURCH IN AMERICA
Employer identification number (EIN):	135562285
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations