401k Plan data: CERTARA VISION PLAN plan

CERTARA VISION PLAN 401k Plan overview

Plan Name	CERTARA VISION PLAN
Plan identification number	508

CERTARA VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

CERTARA USA, INC. has sponsored the creation of one or more 401k plans.

Company Name: CERTARA USA, INC.

Employer identification number (EIN): 510625438

NAIC Classification: 541700

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CERTARA VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2015-01-01
508 2015-01-01
508 2013-01-01 AMY B. STROM
508 2012-01-01 AMY STROM AMY STROM 2013-06-11
508 2011-01-01 DAVID SUMMERS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
508	2015-01-01
508	2015-01-01
508	2013-01-01	AMY B. STROM
508	2012-01-01	AMY STROM	AMY STROM	2013-06-11
508	2011-01-01	DAVID SUMMERS

Plan Statistics for CERTARA VISION PLAN

401k plan membership statisitcs for CERTARA VISION PLAN

Measure Date Value
2015: CERTARA VISION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 77
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 199
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 199
2013: CERTARA VISION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 50
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 47
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
Total of all active and inactive participants 2013-01-01 47
2012: CERTARA VISION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 50
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 50
Total of all active and inactive participants 2012-01-01 50
Total participants 2012-01-01 50
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CERTARA VISION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 50
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 56
Total of all active and inactive participants 2011-01-01 56
Total participants 2011-01-01 56

Measure	Date	Value
2015: CERTARA VISION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	77
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	199
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	199
2013: CERTARA VISION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	50
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	47
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
Total of all active and inactive participants	2013-01-01	47
2012: CERTARA VISION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	50
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	50
Total of all active and inactive participants	2012-01-01	50
Total participants	2012-01-01	50
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CERTARA VISION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	50
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	56
Total of all active and inactive participants	2011-01-01	56
Total participants	2011-01-01	56

Form 5500 Responses for CERTARA VISION PLAN

2015: CERTARA VISION PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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
2013: CERTARA VISION PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
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: CERTARA VISION PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: CERTARA VISION PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30011315

Policy instance

Insurance contract or identification number	30011315
Number of Individuals Covered	199
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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	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 $19,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30011315

Policy instance

Insurance contract or identification number	30011315
Number of Individuals Covered	47
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $783
Total amount of fees paid to insurance company	USD $0
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	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 $10,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $783
Insurance broker organization code?	3
Insurance broker name	THE CORNERSTONE INSURANCE GROUP LLC

VISION SERVICES PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30011315

Policy instance

Insurance contract or identification number	30011315
Number of Individuals Covered	50
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $766
Are there contracts with allocated funds for individual policies?	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $10,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $765
Insurance broker name	THE CORNERSTONE INSURANCE GROUP

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30011315

Policy instance

Insurance contract or identification number	30011315
Number of Individuals Covered	56
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $790
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30011315

Policy instance

Insurance contract or identification number	30011315
Number of Individuals Covered	50
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $828
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $826
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	THE CORNERSTONE INSURANCE GROUP

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Company Name:	CERTARA USA, INC.
Employer identification number (EIN):	510625438
NAIC Classification:	541700