401k Plan data: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN plan

COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 401k Plan overview

Plan Name	COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN
Plan identification number	001

COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

COMMUNITY ACTION FOR HUMAN SERVICES, INC has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY ACTION FOR HUMAN SERVICES, INC

Employer identification number (EIN): 222317376

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 PAIGE BOND 2023-10-10
001 2022-01-01 PAIGE BOND 2024-02-28
001 2021-01-01 PAIGE BOND 2022-12-08
001 2020-01-01 PAIGE BOND 2021-10-13
001 2019-01-01 PAIGE BOND 2020-10-12
001 2018-01-01 PAIGE BOND 2020-02-04
001 2018-01-01 PAIGE BOND 2019-10-14
001 2017-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 PAIGE BOND 2015-10-13
001 2013-01-01 PAIGE BOND 2014-10-14
001 2012-01-01 DAVID BOND 2013-10-10
001 2011-01-01 DAVID BOND 2012-10-03
001 2010-01-01 DAVID BOND 2011-10-13 DAVID BOND 2011-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	PAIGE BOND	2023-10-10
001	2022-01-01	PAIGE BOND	2024-02-28
001	2021-01-01	PAIGE BOND	2022-12-08
001	2020-01-01	PAIGE BOND	2021-10-13
001	2019-01-01	PAIGE BOND	2020-10-12
001	2018-01-01	PAIGE BOND	2020-02-04
001	2018-01-01	PAIGE BOND	2019-10-14
001	2017-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	PAIGE BOND	2015-10-13
001	2013-01-01	PAIGE BOND	2014-10-14
001	2012-01-01	DAVID BOND	2013-10-10
001	2011-01-01	DAVID BOND	2012-10-03
001	2010-01-01	DAVID BOND	2011-10-13	DAVID BOND	2011-10-13

Plan Statistics for COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN

401k plan membership statisitcs for COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN

Measure Date Value
2022: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 61
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 105
Total of all active and inactive participants 2022-01-01 169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 1
Total participants 2022-01-01 170
Number of participants with account balances 2022-01-01 158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 3
2021: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 174
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 78
Number of retired or separated participants receiving benefits 2021-01-01 6
Number of other retired or separated participants entitled to future benefits 2021-01-01 91
Total of all active and inactive participants 2021-01-01 175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 176
Number of participants with account balances 2021-01-01 168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 1
2020: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 89
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 77
Total of all active and inactive participants 2020-01-01 167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 1
Total participants 2020-01-01 168
Number of participants with account balances 2020-01-01 168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 92
Number of retired or separated participants receiving benefits 2019-01-01 3
Number of other retired or separated participants entitled to future benefits 2019-01-01 66
Total of all active and inactive participants 2019-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 162
Number of participants with account balances 2019-01-01 162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 83
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 78
Total of all active and inactive participants 2018-01-01 162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 162
Number of participants with account balances 2018-01-01 162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 11
2017: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 79
Number of retired or separated participants receiving benefits 2017-01-01 3
Number of other retired or separated participants entitled to future benefits 2017-01-01 70
Total of all active and inactive participants 2017-01-01 152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 152
Number of participants with account balances 2017-01-01 152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 6

Measure	Date	Value
2022: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	61
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	105
Total of all active and inactive participants	2022-01-01	169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	170
Number of participants with account balances	2022-01-01	158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	3
2021: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	174
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	78
Number of retired or separated participants receiving benefits	2021-01-01	6
Number of other retired or separated participants entitled to future benefits	2021-01-01	91
Total of all active and inactive participants	2021-01-01	175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	176
Number of participants with account balances	2021-01-01	168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	1
2020: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	89
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	77
Total of all active and inactive participants	2020-01-01	167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	1
Total participants	2020-01-01	168
Number of participants with account balances	2020-01-01	168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	92
Number of retired or separated participants receiving benefits	2019-01-01	3
Number of other retired or separated participants entitled to future benefits	2019-01-01	66
Total of all active and inactive participants	2019-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	162
Number of participants with account balances	2019-01-01	162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	83
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	78
Total of all active and inactive participants	2018-01-01	162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	162
Number of participants with account balances	2018-01-01	162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	11
2017: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	79
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	70
Total of all active and inactive participants	2017-01-01	152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	152
Number of participants with account balances	2017-01-01	152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	6

Financial Data on COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN

Measure	Date	Value
2022 : COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-172,146
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$59,690
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$46,164
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$0
Value of total assets at end of year	2022-12-31	$971,960
Value of total assets at beginning of year	2022-12-31	$1,203,796
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$13,526
Total interest from all sources	2022-12-31	$2,606
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$14,760
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$14,760
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Participant contributions at end of year	2022-12-31	$28,592
Participant contributions at beginning of year	2022-12-31	$28,783
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-231,836
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$971,960
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$1,203,796
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$3,461
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$822,273
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$1,053,687
Interest on participant loans	2022-12-31	$1,310
Interest earned on other investments	2022-12-31	$1,296
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$121,095
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$121,326
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-189,512
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$46,164
Contract administrator fees	2022-12-31	$10,065
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	WILKIN & GUTTENPLAN, P.C.
Accountancy firm EIN	2022-12-31	222612018
2021 : COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$282,736
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$183,472
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$168,874
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$148,553
Value of total assets at end of year	2021-12-31	$1,203,796
Value of total assets at beginning of year	2021-12-31	$1,104,532
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$14,598
Total interest from all sources	2021-12-31	$3,496
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$24,006
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$24,006
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Participant contributions at end of year	2021-12-31	$28,783
Participant contributions at beginning of year	2021-12-31	$54,527
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$685
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$99,264
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,203,796
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,104,532
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$3,536
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,053,687
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$869,177
Interest on participant loans	2021-12-31	$2,258
Interest earned on other investments	2021-12-31	$1,238
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$121,326
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$74,842
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$106,681
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$148,553
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$105,986
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$168,874
Contract administrator fees	2021-12-31	$11,062
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	WILKIN & GUTTENPLAN, P.C.
Accountancy firm EIN	2021-12-31	222612018
2020 : COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$216,921
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$56,783
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$46,770
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$105,986
Value of total assets at end of year	2020-12-31	$1,104,532
Value of total assets at beginning of year	2020-12-31	$944,394
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$10,013
Total interest from all sources	2020-12-31	$1,611
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$14,674
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$14,674
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Participant contributions at end of year	2020-12-31	$54,527
Participant contributions at beginning of year	2020-12-31	$35,256
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$160,138
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,104,532
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$944,394
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$2,378
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$869,177
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$614,165
Interest on participant loans	2020-12-31	$852
Interest earned on other investments	2020-12-31	$759
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$74,842
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$73,679
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$94,650
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$105,986
Employer contributions (assets) at end of year	2020-12-31	$105,986
Employer contributions (assets) at beginning of year	2020-12-31	$221,294
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$46,770
Contract administrator fees	2020-12-31	$7,635
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	WILKIN & GUTTENPLAN, P.C.
Accountancy firm EIN	2020-12-31	222612018
2019 : COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$336,703
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$47,992
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$41,204
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$221,294
Value of total assets at end of year	2019-12-31	$944,394
Value of total assets at beginning of year	2019-12-31	$655,683
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$6,788
Total interest from all sources	2019-12-31	$2,508
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$12,378
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$12,378
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Participant contributions at end of year	2019-12-31	$35,256
Participant contributions at beginning of year	2019-12-31	$34,329
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$288,711
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$944,394
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$655,683
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$782
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$614,165
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$489,314
Interest on participant loans	2019-12-31	$1,708
Interest earned on other investments	2019-12-31	$800
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$73,679
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$66,534
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$100,523
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$221,294
Employer contributions (assets) at end of year	2019-12-31	$221,294
Employer contributions (assets) at beginning of year	2019-12-31	$65,506
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$41,204
Contract administrator fees	2019-12-31	$6,006
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	WILKIN & GUTTENPLAN, P.C.
Accountancy firm EIN	2019-12-31	222612018
2018 : COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$-78,419
Total unrealized appreciation/depreciation of assets	2018-12-31	$-78,419
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$23,409
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$20,042
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$16,992
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$65,506
Value of total assets at end of year	2018-12-31	$655,683
Value of total assets at beginning of year	2018-12-31	$652,316
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$3,050
Total interest from all sources	2018-12-31	$964
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$6,616
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$6,616
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Participant contributions at end of year	2018-12-31	$34,329
Participant contributions at beginning of year	2018-12-31	$13,787
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$3,367
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$655,683
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$652,316
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$489,314
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$455,107
Interest on participant loans	2018-12-31	$964
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$66,534
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$54,520
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$28,742
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$65,506
Employer contributions (assets) at end of year	2018-12-31	$65,506
Employer contributions (assets) at beginning of year	2018-12-31	$128,902
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$16,992
Contract administrator fees	2018-12-31	$3,050
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	WILKIN & GUTTENPLAN, P.C.
Accountancy firm EIN	2018-12-31	222612018
2017 : COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$99,992
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$210,681
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$32,163
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$30,176
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$151,644
Value of total assets at end of year	2017-12-31	$752,307
Value of total assets at beginning of year	2017-12-31	$473,797
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,987
Total interest from all sources	2017-12-31	$452
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$6,299
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$6,299
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Participant contributions at end of year	2017-12-31	$13,786
Participant contributions at beginning of year	2017-12-31	$19,084
Assets. Other investments not covered elsewhere at end of year	2017-12-31	$99,992
Assets. Other investments not covered elsewhere at beginning of year	2017-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$178,518
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$752,307
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$473,797
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$455,107
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$347,038
Interest on participant loans	2017-12-31	$452
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$54,520
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$45,663
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$22,742
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$52,286
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$151,644
Employer contributions (assets) at end of year	2017-12-31	$128,902
Employer contributions (assets) at beginning of year	2017-12-31	$62,012
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$7,434
Contract administrator fees	2017-12-31	$1,987
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	WILKIN & GUTTENPLAN, P.C.
Accountancy firm EIN	2017-12-31	222612018

Form 5500 Responses for COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN

2022: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: COMMUNITY ACTION FOR HUMAN SERVICES, INC PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	161
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $60
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
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 $0
Amount paid for insurance broker fees	60
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	171
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $42
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
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 $0
Amount paid for insurance broker fees	42
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	157
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
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

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	144
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
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

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	143
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $138
Total amount of fees paid to insurance company	USD $29
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
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 $138
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	106
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $112
Total amount of fees paid to insurance company	USD $22
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
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 $112
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	SENTINEL BENEFITS & FINANCIAL GROUP

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

P8-199-999

Policy instance

Insurance contract or identification number	P8-199-999
Number of Individuals Covered	38
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	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?	Yes
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE BROKER
Insurance broker organization code?	3
Insurance broker name	NYLIFE SECURITIES LLC

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Company Name:	COMMUNITY ACTION FOR HUMAN SERVICES, INC
Employer identification number (EIN):	222317376
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities