401k Plan data: GFR MEDIA WELFARE BENEFIT DENTAL PLAN plan

GFR MEDIA WELFARE BENEFIT DENTAL PLAN 401k Plan overview

Plan Name	GFR MEDIA WELFARE BENEFIT DENTAL PLAN
Plan identification number	504

GFR MEDIA WELFARE BENEFIT DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

GFR MEDIA LLC has sponsored the creation of one or more 401k plans.

Company Name: GFR MEDIA LLC

Employer identification number (EIN): 660274149

NAIC Classification: 511110
NAIC Description: Newspaper Publishers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GFR MEDIA WELFARE BENEFIT DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2013-10-01 SAGRY VELAZQUEZ
504 2012-10-01 SAGRY VELAZQUEZ SAGRY VELAZQUEZ 2014-02-27
504 2011-10-01 SAGRY VELAZQUEZ SAGRY VELAZQUEZ 2013-04-22
504 2009-10-01 NORELIS RODRIGUEZ
504 2008-10-01 NORELIS RODRIGUEZ

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2013-10-01	SAGRY VELAZQUEZ
504	2012-10-01	SAGRY VELAZQUEZ	SAGRY VELAZQUEZ	2014-02-27
504	2011-10-01	SAGRY VELAZQUEZ	SAGRY VELAZQUEZ	2013-04-22
504	2009-10-01	NORELIS RODRIGUEZ
504	2008-10-01	NORELIS RODRIGUEZ

Plan Statistics for GFR MEDIA WELFARE BENEFIT DENTAL PLAN

401k plan membership statisitcs for GFR MEDIA WELFARE BENEFIT DENTAL PLAN

Measure Date Value
2013: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 383
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 0
Total of all active and inactive participants 2013-10-01 0
2012: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 373
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 342
Number of retired or separated participants receiving benefits 2012-10-01 27
Number of other retired or separated participants entitled to future benefits 2012-10-01 11
Total of all active and inactive participants 2012-10-01 380
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 3
Total participants 2012-10-01 383
Number of participants with account balances 2012-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 0
Number of employers contributing to the scheme 2012-10-01 0
2011: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 372
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 373
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 0
Total of all active and inactive participants 2011-10-01 373
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 373
Number of participants with account balances 2011-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
Number of employers contributing to the scheme 2011-10-01 0
2009: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 435
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 383
Total of all active and inactive participants 2009-10-01 383
Total participants 2009-10-01 383
2008: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2008 401k membership
Total participants, beginning-of-year 2008-10-01 518
Total number of active participants reported on line 7a of the Form 5500 2008-10-01 435
Total of all active and inactive participants 2008-10-01 435
Total participants 2008-10-01 435

Measure	Date	Value
2013: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	383
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	0
Total of all active and inactive participants	2013-10-01	0
2012: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	373
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	342
Number of retired or separated participants receiving benefits	2012-10-01	27
Number of other retired or separated participants entitled to future benefits	2012-10-01	11
Total of all active and inactive participants	2012-10-01	380
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	3
Total participants	2012-10-01	383
Number of participants with account balances	2012-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	0
Number of employers contributing to the scheme	2012-10-01	0
2011: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	372
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	373
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	0
Total of all active and inactive participants	2011-10-01	373
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	373
Number of participants with account balances	2011-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
Number of employers contributing to the scheme	2011-10-01	0
2009: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	435
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	383
Total of all active and inactive participants	2009-10-01	383
Total participants	2009-10-01	383
2008: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2008 401k membership
Total participants, beginning-of-year	2008-10-01	518
Total number of active participants reported on line 7a of the Form 5500	2008-10-01	435
Total of all active and inactive participants	2008-10-01	435
Total participants	2008-10-01	435

Form 5500 Responses for GFR MEDIA WELFARE BENEFIT DENTAL PLAN

2013: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	Yes
2013-10-01	This submission is the final filing	Yes
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2011: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2009: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2008: GFR MEDIA WELFARE BENEFIT DENTAL PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Multi-employer plan
2008-10-01	Submission has been amended	No
2008-10-01	This submission is the final filing	No
2008-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-10-01	Plan is a collectively bargained plan	No
2008-10-01	Plan funding arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

518

Policy instance

Insurance contract or identification number	518
Number of Individuals Covered	329
Insurance policy start date	2013-10-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $662
Total amount of fees paid to insurance company	USD $7,374
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $662
Amount paid for insurance broker fees	7374
Additional information about fees paid to insurance broker	HEALTH COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	OLYMPIC AGENCY INC

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

518

Policy instance

Insurance contract or identification number	518
Number of Individuals Covered	342
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $864
Total amount of fees paid to insurance company	USD $9,113
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $95,930
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT SERVICES
Insurance broker organization code?	3
Insurance broker name	OLYMPIC AGENCY, INC

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

518

Policy instance

Insurance contract or identification number	518
Number of Individuals Covered	373
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $1,013
Total amount of fees paid to insurance company	USD $9,329
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )

Policy contract number

0518

Policy instance

Insurance contract or identification number	0518
Number of Individuals Covered	372
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $1,176
Total amount of fees paid to insurance company	USD $10,825
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GFR MEDIA LLC
Employer identification number (EIN):	660274149
NAIC Classification:	511110
NAIC Description:	Newspaper Publishers