401k Plan data: F.A. DAVIS MEDICAL PPO PLAN plan

F.A. DAVIS MEDICAL PPO PLAN 401k Plan overview

Plan Name	F.A. DAVIS MEDICAL PPO PLAN
Plan identification number	506

F.A. DAVIS MEDICAL PPO PLAN Benefits

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

401k Sponsoring company profile

F.A. DAVIS COMPANY has sponsored the creation of one or more 401k plans.

Company Name: F.A. DAVIS COMPANY

Employer identification number (EIN): 230512060

NAIC Classification: 511130
NAIC Description: Book Publishers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan F.A. DAVIS MEDICAL PPO PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2014-06-01 SUSAN M TOBIAS
506 2013-06-01 SUSAN M TOBIAS
506 2012-06-01 SUSAN M. TOBIAS
506 2011-06-01 SUSAN M. TOBIAS
506 2009-06-01 CRYSTAL SPRAGGINS
506 2009-06-01 CRYSTAL SPRAGGINS

Plan id#	Filing Submission Date	Name of Administrator
506	2014-06-01	SUSAN M TOBIAS
506	2013-06-01	SUSAN M TOBIAS
506	2012-06-01	SUSAN M. TOBIAS
506	2011-06-01	SUSAN M. TOBIAS
506	2009-06-01	CRYSTAL SPRAGGINS
506	2009-06-01	CRYSTAL SPRAGGINS

Plan Statistics for F.A. DAVIS MEDICAL PPO PLAN

401k plan membership statisitcs for F.A. DAVIS MEDICAL PPO PLAN

Measure Date Value
2014: F.A. DAVIS MEDICAL PPO PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 122
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 0
Number of retired or separated participants receiving benefits 2014-06-01 0
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 0
2013: F.A. DAVIS MEDICAL PPO PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 115
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 117
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 117
2012: F.A. DAVIS MEDICAL PPO PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 117
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 115
Number of retired or separated participants receiving benefits 2012-06-01 0
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 115
2011: F.A. DAVIS MEDICAL PPO PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 120
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 115
Number of retired or separated participants receiving benefits 2011-06-01 1
Total of all active and inactive participants 2011-06-01 116
2009: F.A. DAVIS MEDICAL PPO PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-01 56
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 54
Total of all active and inactive participants 2009-06-01 54
Total participants 2009-06-01 54

Measure	Date	Value
2014: F.A. DAVIS MEDICAL PPO PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	122
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	0
Number of retired or separated participants receiving benefits	2014-06-01	0
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	0
2013: F.A. DAVIS MEDICAL PPO PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	115
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	117
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	117
2012: F.A. DAVIS MEDICAL PPO PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	117
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	115
Number of retired or separated participants receiving benefits	2012-06-01	0
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	115
2011: F.A. DAVIS MEDICAL PPO PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	120
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	115
Number of retired or separated participants receiving benefits	2011-06-01	1
Total of all active and inactive participants	2011-06-01	116
2009: F.A. DAVIS MEDICAL PPO PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	56
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	54
Total of all active and inactive participants	2009-06-01	54
Total participants	2009-06-01	54

Form 5500 Responses for F.A. DAVIS MEDICAL PPO PLAN

2014: F.A. DAVIS MEDICAL PPO PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	No
2014-06-01	This submission is the final filing	Yes
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: F.A. DAVIS MEDICAL PPO PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Submission has been amended	No
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: F.A. DAVIS MEDICAL PPO PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Submission has been amended	No
2012-06-01	This submission is the final filing	No
2012-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-06-01	Plan is a collectively bargained plan	No
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2011: F.A. DAVIS MEDICAL PPO PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Submission has been amended	No
2011-06-01	This submission is the final filing	No
2011-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-06-01	Plan is a collectively bargained plan	No
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2009: F.A. DAVIS MEDICAL PPO PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	Submission has been amended	No
2009-06-01	This submission is the final filing	No
2009-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-06-01	Plan is a collectively bargained plan	No
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

902389

Policy instance

Insurance contract or identification number	902389
Number of Individuals Covered	255
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $50,847
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	Yes
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 $1,108,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,232
Insurance broker organization code?	3
Insurance broker name	CORPORATE SYNERGIES GROUP, LLC

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

37180

Policy instance

Insurance contract or identification number	37180
Number of Individuals Covered	254
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $64,031
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,031
Insurance broker organization code?	3
Insurance broker name	EMERSON REID AND COMPANY, INC.

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

37180

Policy instance

Insurance contract or identification number	37180
Number of Individuals Covered	247
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $60,144
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,144
Insurance broker organization code?	3
Insurance broker name	EMERSON REID AND COMPANY, INC.

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

37180

Policy instance

Insurance contract or identification number	37180
Number of Individuals Covered	230
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $54,512
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

37180

Policy instance

Insurance contract or identification number	37180
Number of Individuals Covered	120
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $35,080
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $539,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	F.A. DAVIS COMPANY
Employer identification number (EIN):	230512060
NAIC Classification:	511130
NAIC Description:	Book Publishers