401k Plan data: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN plan

PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

PEDIATRIC HEALTH CARE ALLIANCE, P.A. has sponsored the creation of one or more 401k plans.

Company Name: PEDIATRIC HEALTH CARE ALLIANCE, P.A.

Employer identification number (EIN): 593483088

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Additional information about PEDIATRIC HEALTH CARE ALLIANCE, P.A.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1996-10-07

Company Identification Number: P96000082597

Legal Registered Office Address: 911 Chestnut Street

Clearwater

33756

More information about PEDIATRIC HEALTH CARE ALLIANCE, P.A.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-01-01 KARALEE KULEK-LUZEY, MD
501 2011-01-01 DREW HURT
501 2010-01-01 MARGARET CONLEY
501 2009-01-01 MARGARET CONLEY

Plan id#	Filing Submission Date	Name of Administrator
501	2012-01-01	KARALEE KULEK-LUZEY, MD
501	2011-01-01	DREW HURT
501	2010-01-01	MARGARET CONLEY
501	2009-01-01	MARGARET CONLEY

Plan Statistics for PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2012: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 175
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 194
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 195
2011: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 202
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 203
2010: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 207
Number of retired or separated participants receiving benefits 2010-01-01 1
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 208
2009: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 191
Number of retired or separated participants receiving benefits 2009-01-01 2
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 193

Measure	Date	Value
2012: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	175
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	194
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	195
2011: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	202
Number of retired or separated participants receiving benefits	2011-01-01	1
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	203
2010: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	207
Number of retired or separated participants receiving benefits	2010-01-01	1
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	208
2009: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	191
Number of retired or separated participants receiving benefits	2009-01-01	2
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	193

Form 5500 Responses for PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN

2012: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS 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: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
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: PEDIATRIC HEALTH CARE ALLIANCE, P.A. HEALTH AND WELFARE BENEFITS 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

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Company Name:	PEDIATRIC HEALTH CARE ALLIANCE, P.A.
Employer identification number (EIN):	593483088
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1996-10-07
Company Identification Number:	P96000082597
Legal Registered Office Address:	911 Chestnut Street Clearwater 33756