401k Plan data: SUNSPIRE HEALTH, LLC VISION PLAN plan

SUNSPIRE HEALTH, LLC VISION PLAN 401k Plan overview

Plan Name	SUNSPIRE HEALTH, LLC VISION PLAN
Plan identification number	503

SUNSPIRE HEALTH, LLC VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

SUNSPIRE HEALTH, LLC has sponsored the creation of one or more 401k plans.

Company Name: SUNSPIRE HEALTH, LLC

Employer identification number (EIN): 455542226

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUNSPIRE HEALTH, LLC VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2016-04-01 CHARECE NEWELL
503 2016-01-01 KYLE WESCOAT KYLE WESCOAT 2016-11-22
503 2016-01-01 KYLE WESCOAT KYLE WESCOAT 2016-11-22
503 2016-01-01 KYLE WESCOAT KYLE WESCOAT 2016-11-22

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2016-04-01	CHARECE NEWELL
503	2016-01-01	KYLE WESCOAT	KYLE WESCOAT	2016-11-22
503	2016-01-01	KYLE WESCOAT	KYLE WESCOAT	2016-11-22
503	2016-01-01	KYLE WESCOAT	KYLE WESCOAT	2016-11-22

Plan Statistics for SUNSPIRE HEALTH, LLC VISION PLAN

401k plan membership statisitcs for SUNSPIRE HEALTH, LLC VISION PLAN

Measure Date Value
2016: SUNSPIRE HEALTH, LLC VISION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 461
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 0
Number of retired or separated participants receiving benefits 2016-04-01 0
Number of other retired or separated participants entitled to future benefits 2016-04-01 0
Total of all active and inactive participants 2016-04-01 0
Total participants, beginning-of-year 2016-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 268
Number of retired or separated participants receiving benefits 2016-01-01 3
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 271

Measure	Date	Value
2016: SUNSPIRE HEALTH, LLC VISION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	461
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	0
Number of retired or separated participants receiving benefits	2016-04-01	0
Number of other retired or separated participants entitled to future benefits	2016-04-01	0
Total of all active and inactive participants	2016-04-01	0
Total participants, beginning-of-year	2016-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	268
Number of retired or separated participants receiving benefits	2016-01-01	3
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	271

Form 5500 Responses for SUNSPIRE HEALTH, LLC VISION PLAN

2016: SUNSPIRE HEALTH, LLC VISION PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Submission has been amended	No
2016-04-01	This submission is the final filing	Yes
2016-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-04-01	Plan is a collectively bargained plan	No
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

1004473/1005208

Policy instance

Insurance contract or identification number	1004473/1005208
Number of Individuals Covered	422
Insurance policy start date	2016-01-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $154
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 $5,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $154
Insurance broker organization code?	3
Insurance broker name	CORPORATE SYNERGIES GROUP

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Company Name:	SUNSPIRE HEALTH, LLC
Employer identification number (EIN):	455542226
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists