401k Plan data: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN plan

HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN
Plan identification number	502

HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

HIGHLANDS DIVERSIFIED, INC. has sponsored the creation of one or more 401k plans.

Company Name: HIGHLANDS DIVERSIFIED, INC.

Employer identification number (EIN): 770382480

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2014-08-01 TOMMY SPRADLING
502 2013-08-01 TOMMY SPRADLING TOMMY SPRADLING 2014-11-24
502 2012-08-01 TOMMY SPRADLING TOMMY SPRADLING 2014-11-24
502 2011-08-01 TOMMY SPRADLING TOMMY SPRADLING 2014-11-24

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2014-08-01	TOMMY SPRADLING
502	2013-08-01	TOMMY SPRADLING	TOMMY SPRADLING	2014-11-24
502	2012-08-01	TOMMY SPRADLING	TOMMY SPRADLING	2014-11-24
502	2011-08-01	TOMMY SPRADLING	TOMMY SPRADLING	2014-11-24

Plan Statistics for HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN

401k plan membership statisitcs for HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN

Measure Date Value
2014: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-08-01 147
Total number of active participants reported on line 7a of the Form 5500 2014-08-01 147
Number of retired or separated participants receiving benefits 2014-08-01 0
Number of other retired or separated participants entitled to future benefits 2014-08-01 0
Total of all active and inactive participants 2014-08-01 147
2013: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-08-01 147
Total number of active participants reported on line 7a of the Form 5500 2013-08-01 147
Number of retired or separated participants receiving benefits 2013-08-01 0
Number of other retired or separated participants entitled to future benefits 2013-08-01 0
Total of all active and inactive participants 2013-08-01 147
2012: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-08-01 147
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 147
Number of retired or separated participants receiving benefits 2012-08-01 0
Number of other retired or separated participants entitled to future benefits 2012-08-01 0
Total of all active and inactive participants 2012-08-01 147
2011: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-08-01 147
Total number of active participants reported on line 7a of the Form 5500 2011-08-01 147
Number of retired or separated participants receiving benefits 2011-08-01 0
Number of other retired or separated participants entitled to future benefits 2011-08-01 0
Total of all active and inactive participants 2011-08-01 147

Measure	Date	Value
2014: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-08-01	147
Total number of active participants reported on line 7a of the Form 5500	2014-08-01	147
Number of retired or separated participants receiving benefits	2014-08-01	0
Number of other retired or separated participants entitled to future benefits	2014-08-01	0
Total of all active and inactive participants	2014-08-01	147
2013: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-08-01	147
Total number of active participants reported on line 7a of the Form 5500	2013-08-01	147
Number of retired or separated participants receiving benefits	2013-08-01	0
Number of other retired or separated participants entitled to future benefits	2013-08-01	0
Total of all active and inactive participants	2013-08-01	147
2012: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-08-01	147
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	147
Number of retired or separated participants receiving benefits	2012-08-01	0
Number of other retired or separated participants entitled to future benefits	2012-08-01	0
Total of all active and inactive participants	2012-08-01	147
2011: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-08-01	147
Total number of active participants reported on line 7a of the Form 5500	2011-08-01	147
Number of retired or separated participants receiving benefits	2011-08-01	0
Number of other retired or separated participants entitled to future benefits	2011-08-01	0
Total of all active and inactive participants	2011-08-01	147

Form 5500 Responses for HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN

2014: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-08-01	Type of plan entity	Single employer plan
2014-08-01	Submission has been amended	No
2014-08-01	This submission is the final filing	No
2014-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-08-01	Plan is a collectively bargained plan	No
2014-08-01	Plan funding arrangement – Insurance	Yes
2014-08-01	Plan benefit arrangement – Insurance	Yes
2013: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-08-01	Type of plan entity	Single employer plan
2013-08-01	Submission has been amended	No
2013-08-01	This submission is the final filing	No
2013-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-08-01	Plan is a collectively bargained plan	No
2013-08-01	Plan funding arrangement – Insurance	Yes
2013-08-01	Plan benefit arrangement – Insurance	Yes
2012: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Submission has been amended	No
2012-08-01	This submission is the final filing	No
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-08-01	Plan is a collectively bargained plan	No
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2011: HIGHLANDS DIVERSIFIED HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-08-01	Type of plan entity	Single employer plan
2011-08-01	First time form 5500 has been submitted	Yes
2011-08-01	Submission has been amended	No
2011-08-01	This submission is the final filing	No
2011-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-08-01	Plan is a collectively bargained plan	No
2011-08-01	Plan funding arrangement – Insurance	Yes
2011-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HOLMAN FAMILY COUNSELING, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

13580

Policy instance

Insurance contract or identification number	13580
Number of Individuals Covered	147
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $164
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
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 $2,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $164
Insurance broker organization code?	3
Insurance broker name	DER MANOUEL INSURANCE GROUP

HOLMAN FAMILY COUNSELING, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

13580

Policy instance

Insurance contract or identification number	13580
Number of Individuals Covered	147
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $134
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
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 $2,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $134
Insurance broker organization code?	3
Insurance broker name	DER MANOUEL INSURANCE GROUP

HOLMAN FAMILY COUNSELING, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

13580

Policy instance

Insurance contract or identification number	13580
Number of Individuals Covered	147
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $134
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
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 $2,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $134
Insurance broker organization code?	3
Insurance broker name	DER MANOUEL INSURANCE GROUP

HOLMAN FAMILY COUNSELING, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

13580

Policy instance

Insurance contract or identification number	13580
Number of Individuals Covered	147
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $134
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
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 $2,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	HIGHLANDS DIVERSIFIED, INC.
Employer identification number (EIN):	770382480
NAIC Classification:	238900