401k Plan data: LIFE WORKS HEALTH & WELFARE PLAN plan

LIFE WORKS HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	LIFE WORKS HEALTH & WELFARE PLAN
Plan identification number	503

LIFE WORKS HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

LIFE WORKS has sponsored the creation of one or more 401k plans.

Company Name: LIFE WORKS

Employer identification number (EIN): 911224761

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Additional information about LIFE WORKS

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1983-09-20

Company Identification Number: 601149791

Legal Registered Office Address: 906 NEW YORK ST

LONGVIEW
United States of America (USA)
986324132

More information about LIFE WORKS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE WORKS HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-01-01
503 2016-01-01 DAVID HILL DAVID HILL 2017-06-14
503 2015-01-01 DAVID HILL DAVID HILL 2016-07-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2017-01-01
503	2016-01-01	DAVID HILL	DAVID HILL	2017-06-14
503	2015-01-01	DAVID HILL	DAVID HILL	2016-07-13

Plan Statistics for LIFE WORKS HEALTH & WELFARE PLAN

401k plan membership statisitcs for LIFE WORKS HEALTH & WELFARE PLAN

Measure Date Value
2017: LIFE WORKS HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 117
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 117
2016: LIFE WORKS HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 106
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 107
2015: LIFE WORKS HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 99
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 100

Measure	Date	Value
2017: LIFE WORKS HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	117
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	117
2016: LIFE WORKS HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	106
Number of retired or separated participants receiving benefits	2016-01-01	1
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	107
2015: LIFE WORKS HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	99
Number of retired or separated participants receiving benefits	2015-01-01	1
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	100

Form 5500 Responses for LIFE WORKS HEALTH & WELFARE PLAN

2017: LIFE WORKS HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: LIFE WORKS HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
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 – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: LIFE WORKS HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

9634

Policy instance

Insurance contract or identification number	9634
Number of Individuals Covered	110
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $19,606
Total amount of fees paid to insurance company	USD $510
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $532,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,606
Amount paid for insurance broker fees	510
Additional information about fees paid to insurance broker	RETENTION BONUS
Insurance broker organization code?	3
Insurance broker name	PROPEL INSURANCE

Potentially related plans

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Company Name:	LIFE WORKS
Employer identification number (EIN):	911224761
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1983-09-20
Company Identification Number:	601149791
Legal Registered Office Address:	906 NEW YORK ST LONGVIEW United States of America (USA) 986324132