401k Plan data: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN plan

EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 401k Plan overview

Plan Name	EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN
Plan identification number	503

EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN Benefits

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

401k Sponsoring company profile

LIGHTHOUSE1 has sponsored the creation of one or more 401k plans.

Company Name: LIGHTHOUSE1

Employer identification number (EIN): 043778810

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-01-01 SHERRY OLSON
503 2011-01-01 LLOYD P NELSON
503 2009-01-01 LLOYD NELSON

Plan id#	Filing Submission Date	Name of Administrator
503	2012-01-01	SHERRY OLSON
503	2011-01-01	LLOYD P NELSON
503	2009-01-01	LLOYD NELSON

Plan Statistics for EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN

401k plan membership statisitcs for EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN

Measure Date Value
2012: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 247
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 247
2011: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 0
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 0
2009: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 110
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 110

Measure	Date	Value
2012: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	247
Number of retired or separated participants receiving benefits	2012-01-01	0
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	247
2011: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	0
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	0
2009: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	110
Number of retired or separated participants receiving benefits	2009-01-01	0
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	110

Form 5500 Responses for EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN

2012: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: EVOLUTION1 GROUP TERM LIFE AND DISABILITY 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	Yes
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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
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 funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Potentially related plans

EVOLUTION1 GROUP TERM LIFE AND DISABILITY PLAN [EIN = 061593514]

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Company Name:	LIGHTHOUSE1
Employer identification number (EIN):	043778810
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services