401k Plan data: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN plan

SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 401k Plan overview

Plan Name	SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN
Plan identification number	503

SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Vision

401k Sponsoring company profile

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

Company Name: SPI HEALTHCARE

Employer identification number (EIN): 371207854

NAIC Classification: 541219
NAIC Description: Other Accounting Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-06-01 JOHN ODONNELL
503 2011-06-01 JOHN ODONNELL
503 2010-06-01 JOHN ODONNELL
503 2009-06-01 MICHAEL BENINATO

Plan id#	Filing Submission Date	Name of Administrator
503	2012-06-01	JOHN ODONNELL
503	2011-06-01	JOHN ODONNELL
503	2010-06-01	JOHN ODONNELL
503	2009-06-01	MICHAEL BENINATO

Plan Statistics for SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN

401k plan membership statisitcs for SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN

Measure Date Value
2012: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 467
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 0
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 0
2011: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 315
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 348
Number of retired or separated participants receiving benefits 2011-06-01 3
Number of other retired or separated participants entitled to future benefits 2011-06-01 0
Total of all active and inactive participants 2011-06-01 351
2010: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2010 401k membership
Total participants, beginning-of-year 2010-06-01 252
Total number of active participants reported on line 7a of the Form 5500 2010-06-01 296
Number of retired or separated participants receiving benefits 2010-06-01 3
Number of other retired or separated participants entitled to future benefits 2010-06-01 0
Total of all active and inactive participants 2010-06-01 299
2009: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-01 158
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 217
Number of retired or separated participants receiving benefits 2009-06-01 4
Number of other retired or separated participants entitled to future benefits 2009-06-01 0
Total of all active and inactive participants 2009-06-01 221

Measure	Date	Value
2012: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	467
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	0
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	0
2011: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	315
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	348
Number of retired or separated participants receiving benefits	2011-06-01	3
Number of other retired or separated participants entitled to future benefits	2011-06-01	0
Total of all active and inactive participants	2011-06-01	351
2010: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2010 401k membership
Total participants, beginning-of-year	2010-06-01	252
Total number of active participants reported on line 7a of the Form 5500	2010-06-01	296
Number of retired or separated participants receiving benefits	2010-06-01	3
Number of other retired or separated participants entitled to future benefits	2010-06-01	0
Total of all active and inactive participants	2010-06-01	299
2009: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	158
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	217
Number of retired or separated participants receiving benefits	2009-06-01	4
Number of other retired or separated participants entitled to future benefits	2009-06-01	0
Total of all active and inactive participants	2009-06-01	221

Form 5500 Responses for SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN

2012: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION 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	Yes
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: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION 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
2010: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2010 form 5500 responses
2010-06-01	Type of plan entity	Single employer plan
2010-06-01	Submission has been amended	No
2010-06-01	This submission is the final filing	No
2010-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-06-01	Plan is a collectively bargained plan	No
2010-06-01	Plan funding arrangement – Insurance	Yes
2010-06-01	Plan benefit arrangement – Insurance	Yes
2009: SPRINGFIELD SERVICE CORPORATION DENTAL AND VISION PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	First time form 5500 has been submitted	Yes
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

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-038471

Policy instance

Insurance contract or identification number	010-038471
Number of Individuals Covered	957
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $24,197
Total amount of fees paid to insurance company	USD $3,674
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	Yes
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 $241,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,197
Amount paid for insurance broker fees	3674
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	MESIROW INSURANCE SERVICES, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30013886

Policy instance

Insurance contract or identification number	30013886
Number of Individuals Covered	352
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $1,458
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 $32,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

30013886

Policy instance

Insurance contract or identification number	30013886
Number of Individuals Covered	303
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $1,400
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 $29,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SPI HEALTHCARE
Employer identification number (EIN):	371207854
NAIC Classification:	541219
NAIC Description:	Other Accounting Services