401k Plan data: REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN plan

REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN
Plan identification number	501

REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Vision

401k Sponsoring company profile

REAL LIFE HEALTHCARE, L.L.C. has sponsored the creation of one or more 401k plans.

Company Name: REAL LIFE HEALTHCARE, L.L.C.

Employer identification number (EIN): 272197605

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-12-01
501 2014-12-01

Plan Statistics for REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN

Measure Date Value
2015: REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-12-01 132
Total number of active participants reported on line 7a of the Form 5500 2015-12-01 0
Total of all active and inactive participants 2015-12-01 0
2014: REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-12-01 0
Total number of active participants reported on line 7a of the Form 5500 2014-12-01 132
Total of all active and inactive participants 2014-12-01 132
Total participants 2014-12-01 132

Measure	Date	Value
2015: REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-12-01	132
Total number of active participants reported on line 7a of the Form 5500	2015-12-01	0
Total of all active and inactive participants	2015-12-01	0
2014: REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-12-01	0
Total number of active participants reported on line 7a of the Form 5500	2014-12-01	132
Total of all active and inactive participants	2014-12-01	132
Total participants	2014-12-01	132

Form 5500 Responses for REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN

2015: REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	This submission is the final filing	Yes
2015-12-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-12-01	Plan funding arrangement – Insurance	Yes
2015-12-01	Plan benefit arrangement – Insurance	Yes
2014: REAL LIFE HEALTHCARE, L.L.C. HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-12-01	Type of plan entity	Single employer plan
2014-12-01	First time form 5500 has been submitted	Yes
2014-12-01	Plan funding arrangement – Insurance	Yes
2014-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DTF80

Policy instance

Insurance contract or identification number	DTF80
Insurance policy start date	2015-12-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,110
Total amount of fees paid to insurance company	USD $161
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, INTENSIVE CARE, ACCIDENT, H
Welfare Benefit Premiums Paid to Carrier	USD $10,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $501
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	ADMIN FEE
Insurance broker organization code?	3
Insurance broker name	JEFFREY C. WEST

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

DTF80

Policy instance

Insurance contract or identification number	DTF80
Number of Individuals Covered	132
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $32,191
Total amount of fees paid to insurance company	USD $1,511
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER, INTENSIVE CARE, ACCIDENT, H
Welfare Benefit Premiums Paid to Carrier	USD $115,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,411
Amount paid for insurance broker fees	12
Additional information about fees paid to insurance broker	ADMIN FEES
Insurance broker organization code?	3
Insurance broker name	JEFFREY PAUL SEPESI

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Company Name:	REAL LIFE HEALTHCARE, L.L.C.
Employer identification number (EIN):	272197605
NAIC Classification:	541600