401k Plan data: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN plan

THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 401k Plan overview

Plan Name	THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN
Plan identification number	502

THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

THE HARKER SCHOOL has sponsored the creation of one or more 401k plans.

Company Name: THE HARKER SCHOOL

Employer identification number (EIN): 941613808

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01
502 2015-01-01
502 2011-01-01 MARISSA LUCKETTI MARISSA LUCKETTI 2012-07-26
502 2010-01-01 MARISSA LUCKETTI MARISSA LUCKETTI 2011-07-06
502 2009-01-01 CLIF WILCOX

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2016-01-01
502	2015-01-01
502	2011-01-01	MARISSA LUCKETTI	MARISSA LUCKETTI	2012-07-26
502	2010-01-01	MARISSA LUCKETTI	MARISSA LUCKETTI	2011-07-06
502	2009-01-01	CLIF WILCOX

Plan Statistics for THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN

401k plan membership statisitcs for THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN

Measure Date Value
2016: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 434
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 464
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 2016-01-01 465
2015: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 409
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 410
Number of retired or separated participants receiving benefits 2015-01-01 5
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 415
2011: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 383
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 380
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 382
2010: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 384
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 378
Number of retired or separated participants receiving benefits 2010-01-01 5
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 383
2009: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 351
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 344
Number of retired or separated participants receiving benefits 2009-01-01 3
Number of other retired or separated participants entitled to future benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 350

Measure	Date	Value
2016: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	434
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	464
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	465
2015: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	409
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	410
Number of retired or separated participants receiving benefits	2015-01-01	5
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	415
2011: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	383
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	380
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	382
2010: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	384
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	378
Number of retired or separated participants receiving benefits	2010-01-01	5
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	383
2009: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	351
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	344
Number of retired or separated participants receiving benefits	2009-01-01	3
Number of other retired or separated participants entitled to future benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	350

Form 5500 Responses for THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN

2016: THE HARKER SCHOOL EMPLOYEES HEALTH CARE 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 funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single 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 – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single 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 – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN 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 – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	39657
Policy instance	1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLTD0AWHN
Policy instance	6
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GVTL0AWHN
Policy instance	5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	GLUG0AWHN
Policy instance	4
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	277654
Policy instance	3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	30036937
Policy instance	2
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number	5398616
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010099971
Policy instance	4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	39657
Policy instance	3
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	357747
Policy instance	2
CLAREMONT (National Association of Insurance Commissioners NAIC id number: 61171 )
Policy contract number	14730
Policy instance	1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	12169694
Policy instance	6
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	12169694
Policy instance	5
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number	5398616
Policy instance	4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	39657
Policy instance	2
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	357747
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	000010099971
Policy instance	3

Potentially related plans

THE HARKER SCHOOL EMPLOYEES HEALTH CARE PLAN [EIN = 941613830]

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Company Name:	THE HARKER SCHOOL
Employer identification number (EIN):	941613808
NAIC Classification:	611000