401k Plan data: FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN plan

FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN 401k Plan overview

Plan Name	FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN
Plan identification number	505

FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN Benefits

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

FRENCH CAMP ACADEMY has sponsored the creation of one or more 401k plans.

Company Name: FRENCH CAMP ACADEMY

Employer identification number (EIN): 640321520

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2011-01-01 WILLIAM M. ADAMS WILLIAM M. ADAMS 2012-07-26
505 2009-01-01 WILLIAM ADAMS WILLIAM ADAMS 2010-07-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2011-01-01	WILLIAM M. ADAMS		WILLIAM M. ADAMS	2012-07-26
505	2009-01-01	WILLIAM ADAMS		WILLIAM ADAMS	2010-07-29

Plan Statistics for FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN

401k plan membership statisitcs for FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN

Measure Date Value
2011: FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 79
Number of retired or separated participants receiving benefits 2011-01-01 1
Total of all active and inactive participants 2011-01-01 80
2009: FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 112
Total of all active and inactive participants 2009-01-01 112
Total participants 2009-01-01 0

Measure	Date	Value
2011: FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	79
Number of retired or separated participants receiving benefits	2011-01-01	1
Total of all active and inactive participants	2011-01-01	80
2009: FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	112
Total of all active and inactive participants	2009-01-01	112
Total participants	2009-01-01	0

Form 5500 Responses for FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN

2011: FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT 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	No
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: FRENCH CAMP ACADEMY EMPLOYEE MEDICAL BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

FRENCH CAMP GRAIN ELEVATORS, LLC 401(K) PLAN [EIN = 680440440]

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Company Name:	FRENCH CAMP ACADEMY
Employer identification number (EIN):	640321520
NAIC Classification:	611000