401k Plan data: LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN plan

LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN 401k Plan overview

Plan Name	LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN
Plan identification number	504

LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

LIFE SCHOOL OF DALLAS has sponsored the creation of one or more 401k plans.

Company Name: LIFE SCHOOL OF DALLAS

Employer identification number (EIN): 752722521

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2012-09-01 CHARLES PULLIAM

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2012-09-01	CHARLES PULLIAM

Plan Statistics for LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN

401k plan membership statisitcs for LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN

Measure Date Value
2012: LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 383
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 0
Number of retired or separated participants receiving benefits 2012-09-01 0
Number of other retired or separated participants entitled to future benefits 2012-09-01 0
Total of all active and inactive participants 2012-09-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-09-01 0
Total participants 2012-09-01 0
Number of participants with account balances 2012-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-09-01 0

Measure	Date	Value
2012: LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	383
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	0
Number of retired or separated participants receiving benefits	2012-09-01	0
Number of other retired or separated participants entitled to future benefits	2012-09-01	0
Total of all active and inactive participants	2012-09-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-09-01	0
Total participants	2012-09-01	0
Number of participants with account balances	2012-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-09-01	0

Form 5500 Responses for LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN

2012: LIFE SCHOOL OF DALLAS, INC. GROUP DENTAL PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	Yes
2012-09-01	This submission is the final filing	Yes
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3336092

Policy instance

Insurance contract or identification number	3336092
Number of Individuals Covered	284
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $11,974
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 $121,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $11,974
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FINANCIAL BENEFIT SERVICES LLC

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FG1D0480

Policy instance

Insurance contract or identification number	FG1D0480
Number of Individuals Covered	245
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $7,403
Total amount of fees paid to insurance company	USD $8,166
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 $148,058

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Company Name:	LIFE SCHOOL OF DALLAS
Employer identification number (EIN):	752722521
NAIC Classification:	611000