401k Plan data: BLUEAPPLE GROUP VISION PLAN plan

BLUEAPPLE GROUP VISION PLAN 401k Plan overview

Plan Name	BLUEAPPLE GROUP VISION PLAN
Plan identification number	503

BLUEAPPLE GROUP VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

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

Company Name: BLUEAPPLE INC.

Employer identification number (EIN): 113019324

NAIC Classification: 522300
NAIC Description: Activities Related to Credit Intermediation

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUEAPPLE GROUP VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-04-01 AYMAN IBRAHIM
503 2011-04-01 AYMAN IBRAHIM
503 2010-04-01 AYMAN IBRAHIM RAY SIDHOM 2011-10-17
503 2009-04-01 AYMAN IBRAHIM AYMAN IBRAHIM 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2012-04-01	AYMAN IBRAHIM
503	2011-04-01	AYMAN IBRAHIM
503	2010-04-01	AYMAN IBRAHIM	RAY SIDHOM	2011-10-17
503	2009-04-01	AYMAN IBRAHIM	AYMAN IBRAHIM	2010-10-15

Plan Statistics for BLUEAPPLE GROUP VISION PLAN

401k plan membership statisitcs for BLUEAPPLE GROUP VISION PLAN

Measure Date Value
2012: BLUEAPPLE GROUP VISION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-04-01 150
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 193
Number of retired or separated participants receiving benefits 2012-04-01 0
Number of other retired or separated participants entitled to future benefits 2012-04-01 0
Total of all active and inactive participants 2012-04-01 193
2011: BLUEAPPLE GROUP VISION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-04-01 146
Total number of active participants reported on line 7a of the Form 5500 2011-04-01 150
Number of retired or separated participants receiving benefits 2011-04-01 0
Number of other retired or separated participants entitled to future benefits 2011-04-01 0
Total of all active and inactive participants 2011-04-01 150
2010: BLUEAPPLE GROUP VISION PLAN 2010 401k membership
Total participants, beginning-of-year 2010-04-01 145
Total number of active participants reported on line 7a of the Form 5500 2010-04-01 146
Number of retired or separated participants receiving benefits 2010-04-01 0
Number of other retired or separated participants entitled to future benefits 2010-04-01 0
Total of all active and inactive participants 2010-04-01 146
2009: BLUEAPPLE GROUP VISION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-04-01 131
Total number of active participants reported on line 7a of the Form 5500 2009-04-01 145
Number of retired or separated participants receiving benefits 2009-04-01 0
Number of other retired or separated participants entitled to future benefits 2009-04-01 0
Total of all active and inactive participants 2009-04-01 145

Measure	Date	Value
2012: BLUEAPPLE GROUP VISION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-04-01	150
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	193
Number of retired or separated participants receiving benefits	2012-04-01	0
Number of other retired or separated participants entitled to future benefits	2012-04-01	0
Total of all active and inactive participants	2012-04-01	193
2011: BLUEAPPLE GROUP VISION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-04-01	146
Total number of active participants reported on line 7a of the Form 5500	2011-04-01	150
Number of retired or separated participants receiving benefits	2011-04-01	0
Number of other retired or separated participants entitled to future benefits	2011-04-01	0
Total of all active and inactive participants	2011-04-01	150
2010: BLUEAPPLE GROUP VISION PLAN 2010 401k membership
Total participants, beginning-of-year	2010-04-01	145
Total number of active participants reported on line 7a of the Form 5500	2010-04-01	146
Number of retired or separated participants receiving benefits	2010-04-01	0
Number of other retired or separated participants entitled to future benefits	2010-04-01	0
Total of all active and inactive participants	2010-04-01	146
2009: BLUEAPPLE GROUP VISION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-04-01	131
Total number of active participants reported on line 7a of the Form 5500	2009-04-01	145
Number of retired or separated participants receiving benefits	2009-04-01	0
Number of other retired or separated participants entitled to future benefits	2009-04-01	0
Total of all active and inactive participants	2009-04-01	145

Form 5500 Responses for BLUEAPPLE GROUP VISION PLAN

2012: BLUEAPPLE GROUP VISION PLAN 2012 form 5500 responses
2012-04-01	Type of plan entity	Mulitple employer plan
2012-04-01	Submission has been amended	No
2012-04-01	This submission is the final filing	No
2012-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-04-01	Plan is a collectively bargained plan	No
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes
2011: BLUEAPPLE GROUP VISION PLAN 2011 form 5500 responses
2011-04-01	Type of plan entity	Mulitple employer plan
2011-04-01	Submission has been amended	Yes
2011-04-01	This submission is the final filing	No
2011-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-04-01	Plan is a collectively bargained plan	No
2011-04-01	Plan funding arrangement – Insurance	Yes
2011-04-01	Plan benefit arrangement – Insurance	Yes
2010: BLUEAPPLE GROUP VISION PLAN 2010 form 5500 responses
2010-04-01	Type of plan entity	Mulitple employer plan
2010-04-01	Submission has been amended	No
2010-04-01	This submission is the final filing	No
2010-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-04-01	Plan is a collectively bargained plan	No
2010-04-01	Plan funding arrangement – Insurance	Yes
2010-04-01	Plan benefit arrangement – Insurance	Yes
2009: BLUEAPPLE GROUP VISION PLAN 2009 form 5500 responses
2009-04-01	Type of plan entity	Single employer plan
2009-04-01	First time form 5500 has been submitted	Yes
2009-04-01	Submission has been amended	No
2009-04-01	This submission is the final filing	No
2009-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-04-01	Plan is a collectively bargained plan	No
2009-04-01	Plan funding arrangement – Insurance	Yes
2009-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

472639

Policy instance

Insurance contract or identification number	472639
Number of Individuals Covered	193
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $1,448
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	No
Vision Insurance Welfare Benefit	Yes
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 $15,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,448
Insurance broker organization code?	3
Insurance broker name	GROUP ASSOCIATES, INC.

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

EVO-001

Policy instance

Insurance contract or identification number	EVO-001
Number of Individuals Covered	259
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $1,419
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	No
Vision Insurance Welfare Benefit	Yes
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 $15,769

HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 )

Policy contract number

EVO-001

Policy instance

Insurance contract or identification number	EVO-001
Number of Individuals Covered	251
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $1,211
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	No
Vision Insurance Welfare Benefit	Yes
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 $13,452

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Company Name:	BLUEAPPLE INC.
Employer identification number (EIN):	113019324
NAIC Classification:	522300
NAIC Description:	Activities Related to Credit Intermediation