401k Plan data: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL plan

ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 401k Plan overview

Plan Name	ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL
Plan identification number	504

ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness)

401k Sponsoring company profile

ATHLETICO LTD has sponsored the creation of one or more 401k plans.

Company Name: ATHLETICO LTD

Employer identification number (EIN): 363771769

NAIC Classification: 621340
NAIC Description: Offices of Physical, Occupational and Speech Therapists, and Audiologists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2013-01-01 MARK KAUFMAN
504 2013-01-01
504 2012-01-01 MARK KAUFMAN
504 2009-01-01 MARK KAUFMAN

Plan Statistics for ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL

401k plan membership statisitcs for ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL

Measure Date Value
2013: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2013 401k membership
Total participants, beginning-of-year 2013-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 148
Total of all active and inactive participants 2013-01-01 148
Total participants 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
2012: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2012 401k membership
Total participants, beginning-of-year 2012-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 138
Total of all active and inactive participants 2012-01-01 138
Total participants 2012-01-01 0
2009: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2009 401k membership
Total participants, beginning-of-year 2009-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 140
Total of all active and inactive participants 2009-01-01 140
Total participants 2009-01-01 140

Measure	Date	Value
2013: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2013 401k membership
Total participants, beginning-of-year	2013-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	148
Total of all active and inactive participants	2013-01-01	148
Total participants	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
2012: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2012 401k membership
Total participants, beginning-of-year	2012-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	138
Total of all active and inactive participants	2012-01-01	138
Total participants	2012-01-01	0
2009: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2009 401k membership
Total participants, beginning-of-year	2009-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	140
Total of all active and inactive participants	2009-01-01	140
Total participants	2009-01-01	140

Form 5500 Responses for ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL

2013: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	Yes
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2009: ATHLETICO, LTD LIFE STYLE LIFE AD&D (SUPPLEMENTAL 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

127892

Policy instance

Insurance contract or identification number	127892
Number of Individuals Covered	148
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of fees paid to insurance company	USD $5,252
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5252
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Total amount of commissions paid to insurance broker	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	No
Dental Insurance Welfare Benefit	No
Vision 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
Insurance broker name	CBIZ BENEFITS & INSURANCE SERV

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

127892

Policy instance

Insurance contract or identification number	127892
Number of Individuals Covered	138
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of fees paid to insurance company	USD $4,558
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4558
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CBIZ BENEFITS & INSURANCE SERV

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

127892

Policy instance

Insurance contract or identification number	127892
Total amount of fees paid to insurance company	USD $2,573
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2573
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CBIZ BENEFITS & INSURANCE SERV

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Company Name:	ATHLETICO LTD
Employer identification number (EIN):	363771769
NAIC Classification:	621340
NAIC Description:	Offices of Physical, Occupational and Speech Therapists, and Audiologists

Plan id#	Filing Submission Date	Name of Administrator
504	2013-01-01	MARK KAUFMAN
504	2013-01-01
504	2012-01-01	MARK KAUFMAN
504	2009-01-01	MARK KAUFMAN