401k Plan data: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA plan

AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 401k Plan overview

Plan Name	AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA
Plan identification number	501

AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

AFFORDABLE CARE, LLC has sponsored the creation of one or more 401k plans.

Company Name: AFFORDABLE CARE, LLC

Employer identification number (EIN): 561505559

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Additional information about AFFORDABLE CARE, LLC

Jurisdiction of Incorporation: Vermont Secretary of State Corporations Division

Incorporation Date: 2003-04-11

Company Identification Number: 75603

Legal Registered Office Address: 400 CORNERSTONE DR #240

WILLISTON
United States of America (USA)
05495

More information about AFFORDABLE CARE, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01 PAUL STEELMAN
501 2015-01-01 PAUL STEELMAN
501 2014-01-01 PAUL STEELMAN PAUL STEELMAN 2015-10-09
501 2013-01-01 PAUL STEELMAN
501 2011-01-01 PAUL STEELMAN
501 2009-01-01 PAUL STEELMAN 2010-07-28

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-01-01	PAUL STEELMAN
501	2015-01-01	PAUL STEELMAN
501	2014-01-01	PAUL STEELMAN	PAUL STEELMAN	2015-10-09
501	2013-01-01	PAUL STEELMAN
501	2011-01-01	PAUL STEELMAN
501	2009-01-01		PAUL STEELMAN	2010-07-28

Plan Statistics for AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA

401k plan membership statisitcs for AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA

Measure Date Value
2016: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2016 401k membership
Total participants, beginning-of-year 2016-01-01 248
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
2015: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2015 401k membership
Total participants, beginning-of-year 2015-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 162
Number of retired or separated participants receiving benefits 2015-01-01 10
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 172
2014: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2014 401k membership
Total participants, beginning-of-year 2014-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 148
Total of all active and inactive participants 2014-01-01 148
Total participants 2014-01-01 148
2013: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2013 401k membership
Total participants, beginning-of-year 2013-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 139
Total of all active and inactive participants 2013-01-01 139
Total participants 2013-01-01 139
2011: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2011 401k membership
Total participants, beginning-of-year 2011-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 202
Total of all active and inactive participants 2011-01-01 202
Total participants 2011-01-01 202
2009: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2009 401k membership
Total participants, beginning-of-year 2009-01-01 179
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 190
Total of all active and inactive participants 2009-01-01 190
Total participants 2009-01-01 190

Measure	Date	Value
2016: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2016 401k membership
Total participants, beginning-of-year	2016-01-01	248
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
2015: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2015 401k membership
Total participants, beginning-of-year	2015-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	162
Number of retired or separated participants receiving benefits	2015-01-01	10
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	172
2014: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2014 401k membership
Total participants, beginning-of-year	2014-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	148
Total of all active and inactive participants	2014-01-01	148
Total participants	2014-01-01	148
2013: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2013 401k membership
Total participants, beginning-of-year	2013-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	139
Total of all active and inactive participants	2013-01-01	139
Total participants	2013-01-01	139
2011: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2011 401k membership
Total participants, beginning-of-year	2011-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	202
Total of all active and inactive participants	2011-01-01	202
Total participants	2011-01-01	202
2009: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2009 401k membership
Total participants, beginning-of-year	2009-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	190
Total of all active and inactive participants	2009-01-01	190
Total participants	2009-01-01	190

Form 5500 Responses for AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA

2016: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2016 form 5500 responses
2016-01-01	Type of plan entity	Multi-employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
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 – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-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 – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple 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 – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-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 – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: AFFORDABLE CARE, LLC MEDICAL/LIMITED FSA 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DISCOVERY BENEFITS (National Association of Insurance Commissioners NAIC id number: 54121 )

Policy contract number

ACI3

Policy instance

Insurance contract or identification number	ACI3
Number of Individuals Covered	148
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	FLEXIBLE SPENDING, MEDICAL SAVINGS ACCOUNT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	AFFORDABLE CARE, LLC
Employer identification number (EIN):	561505559
NAIC Classification:	621210
NAIC Description:	Offices of Dentists

Jurisdiction of Incorporation:	Vermont Secretary of State Corporations Division
Incorporation Date:	2003-04-11
Company Identification Number:	75603
Legal Registered Office Address:	400 CORNERSTONE DR #240 WILLISTON United States of America (USA) 05495