401k Plan data: EXPERIENCE WORKS, INC.

EXPERIENCE WORKS, INC. - DENTAL PLAN 401k Plan overview

Plan Name	EXPERIENCE WORKS, INC. - DENTAL PLAN
Plan identification number	513

EXPERIENCE WORKS, INC. - DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

EXPERIENCE WORKS, INC. has sponsored the creation of one or more 401k plans.

Company Name: EXPERIENCE WORKS, INC.

Employer identification number (EIN): 520817955

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

Additional information about EXPERIENCE WORKS, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1993-08-20

Company Identification Number: 0009671307

Legal Registered Office Address: 900 AUSTIN AVE STE 303

WACO
United States of America (USA)
76701

More information about EXPERIENCE WORKS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EXPERIENCE WORKS, INC. - DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
513 2014-07-01
513 2013-07-01 FANNY CASTELLAR, HR BENEFITS ADMIN
513 2012-07-01 FANNY CASTELLAR, HR BENEFITS ADMIN
513 2011-07-01 WILLIAM DODSON, DIR HUMAN RESOURCES
513 2009-07-01 WILLIAM DODSON, DIR HUMAN RESOURCES 2011-04-15
513 2009-07-01 WILLIAM DODSON, DIR HUMAN RESOURCES

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
513	2014-07-01
513	2013-07-01	FANNY CASTELLAR, HR BENEFITS ADMIN
513	2012-07-01	FANNY CASTELLAR, HR BENEFITS ADMIN
513	2011-07-01	WILLIAM DODSON, DIR HUMAN RESOURCES
513	2009-07-01		WILLIAM DODSON, DIR HUMAN RESOURCES	2011-04-15
513	2009-07-01	WILLIAM DODSON, DIR HUMAN RESOURCES

Plan Statistics for EXPERIENCE WORKS, INC. - DENTAL PLAN

401k plan membership statisitcs for EXPERIENCE WORKS, INC. - DENTAL PLAN

Measure Date Value
2014: EXPERIENCE WORKS, INC. - DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 255
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 0
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 0
2013: EXPERIENCE WORKS, INC. - DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 272
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 247
Number of retired or separated participants receiving benefits 2013-07-01 8
Total of all active and inactive participants 2013-07-01 255
2012: EXPERIENCE WORKS, INC. - DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 288
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 266
Number of retired or separated participants receiving benefits 2012-07-01 6
Total of all active and inactive participants 2012-07-01 272
2011: EXPERIENCE WORKS, INC. - DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 439
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 277
Number of retired or separated participants receiving benefits 2011-07-01 11
Total of all active and inactive participants 2011-07-01 288
2009: EXPERIENCE WORKS, INC. - DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 325
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 435
Number of retired or separated participants receiving benefits 2009-07-01 6
Number of other retired or separated participants entitled to future benefits 2009-07-01 0
Total of all active and inactive participants 2009-07-01 441

Measure	Date	Value
2014: EXPERIENCE WORKS, INC. - DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	255
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	0
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	0
2013: EXPERIENCE WORKS, INC. - DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	272
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	247
Number of retired or separated participants receiving benefits	2013-07-01	8
Total of all active and inactive participants	2013-07-01	255
2012: EXPERIENCE WORKS, INC. - DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	288
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	266
Number of retired or separated participants receiving benefits	2012-07-01	6
Total of all active and inactive participants	2012-07-01	272
2011: EXPERIENCE WORKS, INC. - DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	439
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	277
Number of retired or separated participants receiving benefits	2011-07-01	11
Total of all active and inactive participants	2011-07-01	288
2009: EXPERIENCE WORKS, INC. - DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	325
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	435
Number of retired or separated participants receiving benefits	2009-07-01	6
Number of other retired or separated participants entitled to future benefits	2009-07-01	0
Total of all active and inactive participants	2009-07-01	441

Form 5500 Responses for EXPERIENCE WORKS, INC. - DENTAL PLAN

2014: EXPERIENCE WORKS, INC. - DENTAL PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	Yes
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: EXPERIENCE WORKS, INC. - DENTAL PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: EXPERIENCE WORKS, INC. - DENTAL PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: EXPERIENCE WORKS, INC. - DENTAL PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2009: EXPERIENCE WORKS, INC. - DENTAL PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05595946

Policy instance

Insurance contract or identification number	TM05595946
Number of Individuals Covered	447
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $3,855
Total amount of fees paid to insurance company	USD $982
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	Yes
Vision Insurance Welfare Benefit	No
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 $101,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,444
Amount paid for insurance broker fees	982
Additional information about fees paid to insurance broker	COMMISSIONS AND FEES
Insurance broker organization code?	3
Insurance broker name	NFP INS SERVICES, INC.

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05595946

Policy instance

Insurance contract or identification number	TM05595946
Number of Individuals Covered	335
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $3,584
Total amount of fees paid to insurance company	USD $792
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	Yes
Vision Insurance Welfare Benefit	No
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 $117,484
Commission paid to Insurance Broker	USD $3,584
Amount paid for insurance broker fees	792
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LIFETIME BENEFITS LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05595946

Policy instance

Insurance contract or identification number	TM05595946
Number of Individuals Covered	358
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $3,517
Total amount of fees paid to insurance company	USD $349
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	Yes
Vision Insurance Welfare Benefit	No
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 $96,372
Commission paid to Insurance Broker	USD $1,623
Amount paid for insurance broker fees	349
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	STEWART A BODE

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05595946

Policy instance

Insurance contract or identification number	TM05595946
Number of Individuals Covered	360
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $3,702
Total amount of fees paid to insurance company	USD $20
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	Yes
Vision Insurance Welfare Benefit	No
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 $113,112

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05595946

Policy instance

Insurance contract or identification number	TM05595946
Number of Individuals Covered	458
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $4,271
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	Yes
Vision Insurance Welfare Benefit	No
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 $147,408

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Company Name:	EXPERIENCE WORKS, INC.
Employer identification number (EIN):	520817955
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1993-08-20
Company Identification Number:	0009671307
Legal Registered Office Address:	900 AUSTIN AVE STE 303 WACO United States of America (USA) 76701