401k Plan data: EVOKE THERAPY plan

EVOKE THERAPY 401k Plan overview

Plan Name	EVOKE THERAPY
Plan identification number	502

EVOKE THERAPY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

EVOKE AT ENTRADA, LLC has sponsored the creation of one or more 401k plans.

Company Name: EVOKE AT ENTRADA, LLC

Employer identification number (EIN): 201596097

NAIC Classification: 621330
NAIC Description: Offices of Mental Health Practitioners (except Physicians)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EVOKE THERAPY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01 RICK HEIZER
502 2015-01-01 RICK H

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2016-01-01	RICK HEIZER
502	2015-01-01	RICK H

Plan Statistics for EVOKE THERAPY

401k plan membership statisitcs for EVOKE THERAPY

Measure Date Value
2016: EVOKE THERAPY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 131
Total of all active and inactive participants 2016-01-01 131
2015: EVOKE THERAPY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 103
Total of all active and inactive participants 2015-01-01 103

Measure	Date	Value
2016: EVOKE THERAPY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	131
Total of all active and inactive participants	2016-01-01	131
2015: EVOKE THERAPY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	103
Total of all active and inactive participants	2015-01-01	103

Form 5500 Responses for EVOKE THERAPY

2016: EVOKE THERAPY 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: EVOKE THERAPY 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

875668G

Policy instance

Insurance contract or identification number	875668G
Number of Individuals Covered	359
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,513
Total amount of fees paid to insurance company	USD $1,899
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $33,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,513
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	LEAVITT GROUP AGCY ASS

Potentially related plans

EVOKE THERAPY PROGRAMS 401(K) PLAN [EIN = 453981399]

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Company Name:	EVOKE AT ENTRADA, LLC
Employer identification number (EIN):	201596097
NAIC Classification:	621330
NAIC Description:	Offices of Mental Health Practitioners (except Physicians)