IRENE STACY COMMUNITY MENTAL HEALTH CENTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER
401k plan membership statisitcs for 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER
Measure | Date | Value |
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2017 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2017 401k financial data |
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Total income from all sources | 2017-08-31 | $86,698 |
Expenses. Total of all expenses incurred | 2017-08-31 | $1,266,189 |
Benefits paid (including direct rollovers) | 2017-08-31 | $1,231,780 |
Total plan assets at end of year | 2017-08-31 | $0 |
Total plan assets at beginning of year | 2017-08-31 | $1,179,491 |
Total contributions received or receivable from participants | 2017-08-31 | $0 |
Assets. Value of loans (other than to participants) | 2017-08-31 | $0 |
Expenses. Other expenses not covered elsewhere | 2017-08-31 | $34,409 |
Other income received | 2017-08-31 | $86,698 |
Net income (gross income less expenses) | 2017-08-31 | $-1,179,491 |
Net plan assets at end of year (total assets less liabilities) | 2017-08-31 | $0 |
Net plan assets at beginning of year (total assets less liabilities) | 2017-08-31 | $1,179,491 |
Total contributions received or receivable from employer(s) | 2017-08-31 | $0 |
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2017-08-31 | $0 |
2016 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2016 401k financial data |
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Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $0 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $0 |
Total income from all sources (including contributions) | 2016-12-31 | $48,701 |
Total loss/gain on sale of assets | 2016-12-31 | $0 |
Total of all expenses incurred | 2016-12-31 | $632,131 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $631,381 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $0 |
Value of total assets at end of year | 2016-12-31 | $1,179,491 |
Value of total assets at beginning of year | 2016-12-31 | $1,762,921 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $750 |
Total interest from all sources | 2016-12-31 | $48,701 |
Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $0 |
Was this plan covered by a fidelity bond | 2016-12-31 | No |
If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2016-12-31 | $0 |
Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
Participant contributions at beginning of year | 2016-12-31 | $1,755 |
Administrative expenses (other) incurred | 2016-12-31 | $750 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
Value of net income/loss | 2016-12-31 | $-583,430 |
Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $1,179,491 |
Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $1,762,921 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
Value of interest in pooled separate accounts at end of year | 2016-12-31 | $621,421 |
Value of interest in pooled separate accounts at beginning of year | 2016-12-31 | $1,014,775 |
Interest earned on other investments | 2016-12-31 | $48,701 |
Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2016-12-31 | $558,070 |
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2016-12-31 | $746,391 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $631,381 |
Did the plan have assets held for investment | 2016-12-31 | 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 | 2016-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Disclaimer |
Accountancy firm name | 2016-12-31 | LAW OFFICE OF MATTHEW J. BORROR |
Accountancy firm EIN | 2016-12-31 | 272898041 |
2015 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2015 401k financial data |
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Total income from all sources (including contributions) | 2015-12-31 | $68,659 |
Total of all expenses incurred | 2015-12-31 | $743,160 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $742,030 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $63,192 |
Value of total assets at end of year | 2015-12-31 | $1,762,921 |
Value of total assets at beginning of year | 2015-12-31 | $2,437,422 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $1,130 |
Total interest from all sources | 2015-12-31 | $10,324 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
Was this plan covered by a fidelity bond | 2015-12-31 | No |
If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
Contributions received from participants | 2015-12-31 | $59,062 |
Participant contributions at end of year | 2015-12-31 | $1,755 |
Participant contributions at beginning of year | 2015-12-31 | $5,639 |
Income. Received or receivable in cash from other sources (including rollovers) | 2015-12-31 | $4,130 |
Administrative expenses (other) incurred | 2015-12-31 | $1,130 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
Value of net income/loss | 2015-12-31 | $-674,501 |
Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $1,762,921 |
Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $2,437,422 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
Value of interest in pooled separate accounts at end of year | 2015-12-31 | $1,014,775 |
Value of interest in pooled separate accounts at beginning of year | 2015-12-31 | $1,554,023 |
Interest earned on other investments | 2015-12-31 | $10,324 |
Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2015-12-31 | $746,391 |
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2015-12-31 | $841,690 |
Net investment gain/loss from pooled separate accounts | 2015-12-31 | $-4,857 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | Yes |
Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
Employer contributions (assets) at beginning of year | 2015-12-31 | $36,070 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $742,030 |
Did the plan have assets held for investment | 2015-12-31 | 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 | 2015-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Disclaimer |
Accountancy firm name | 2015-12-31 | MAHER DUESSEL, CPAS |
Accountancy firm EIN | 2015-12-31 | 251622758 |
2014 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2014 401k financial data |
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Total income from all sources (including contributions) | 2014-12-31 | $309,556 |
Total of all expenses incurred | 2014-12-31 | $678,382 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $677,200 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $190,613 |
Value of total assets at end of year | 2014-12-31 | $2,437,422 |
Value of total assets at beginning of year | 2014-12-31 | $2,806,248 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $1,182 |
Total interest from all sources | 2014-12-31 | $11,610 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
Value of fidelity bond cover | 2014-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
Funding deficiency by the employer to the plan for this plan year | 2014-12-31 | $0 |
Minimum employer required contribution for this plan year | 2014-12-31 | $44,799 |
Amount contributed by the employer to the plan for this plan year | 2014-12-31 | $44,799 |
Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
Contributions received from participants | 2014-12-31 | $81,952 |
Participant contributions at end of year | 2014-12-31 | $5,639 |
Participant contributions at beginning of year | 2014-12-31 | $3,823 |
Income. Received or receivable in cash from other sources (including rollovers) | 2014-12-31 | $63,862 |
Administrative expenses (other) incurred | 2014-12-31 | $1,182 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
Value of net income/loss | 2014-12-31 | $-368,826 |
Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $2,437,422 |
Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $2,806,248 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
Value of interest in pooled separate accounts at end of year | 2014-12-31 | $1,554,023 |
Value of interest in pooled separate accounts at beginning of year | 2014-12-31 | $1,729,905 |
Interest earned on other investments | 2014-12-31 | $11,610 |
Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2014-12-31 | $841,690 |
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2014-12-31 | $1,039,973 |
Net investment gain/loss from pooled separate accounts | 2014-12-31 | $107,333 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | Yes |
Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
Contributions received in cash from employer | 2014-12-31 | $44,799 |
Employer contributions (assets) at end of year | 2014-12-31 | $36,070 |
Employer contributions (assets) at beginning of year | 2014-12-31 | $32,547 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $677,200 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-12-31 | No |
Did the plan have assets held for investment | 2014-12-31 | 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 | 2014-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | Yes |
Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Disclaimer |
Accountancy firm name | 2014-12-31 | MAHER DUESSEL, CPAS |
Accountancy firm EIN | 2014-12-31 | 251622758 |
2013 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2013 401k financial data |
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Total income from all sources (including contributions) | 2013-12-31 | $539,998 |
Total of all expenses incurred | 2013-12-31 | $717,027 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $715,859 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $175,826 |
Value of total assets at end of year | 2013-12-31 | $2,806,248 |
Value of total assets at beginning of year | 2013-12-31 | $2,983,277 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $1,168 |
Total interest from all sources | 2013-12-31 | $15,425 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
Value of fidelity bond cover | 2013-12-31 | $1,000,000 |
If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
Funding deficiency by the employer to the plan for this plan year | 2013-12-31 | $0 |
Minimum employer required contribution for this plan year | 2013-12-31 | $42,387 |
Amount contributed by the employer to the plan for this plan year | 2013-12-31 | $42,387 |
Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
Contributions received from participants | 2013-12-31 | $66,380 |
Participant contributions at end of year | 2013-12-31 | $3,823 |
Participant contributions at beginning of year | 2013-12-31 | $4,125 |
Assets. Other investments not covered elsewhere at beginning of year | 2013-12-31 | $19,010 |
Income. Received or receivable in cash from other sources (including rollovers) | 2013-12-31 | $67,059 |
Other income not declared elsewhere | 2013-12-31 | $2,577 |
Administrative expenses (other) incurred | 2013-12-31 | $1,168 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
Value of net income/loss | 2013-12-31 | $-177,029 |
Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $2,806,248 |
Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $2,983,277 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
Value of interest in pooled separate accounts at end of year | 2013-12-31 | $1,729,905 |
Value of interest in pooled separate accounts at beginning of year | 2013-12-31 | $1,632,973 |
Interest earned on other investments | 2013-12-31 | $15,425 |
Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2013-12-31 | $1,039,973 |
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2013-12-31 | $1,291,458 |
Net investment gain/loss from pooled separate accounts | 2013-12-31 | $346,170 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | Yes |
Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
Contributions received in cash from employer | 2013-12-31 | $42,387 |
Employer contributions (assets) at end of year | 2013-12-31 | $32,547 |
Employer contributions (assets) at beginning of year | 2013-12-31 | $35,711 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $715,859 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-12-31 | No |
Did the plan have assets held for investment | 2013-12-31 | 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 | 2013-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | Yes |
Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Disclaimer |
Accountancy firm name | 2013-12-31 | MAHER DUESSEL, CPAS |
Accountancy firm EIN | 2013-12-31 | 251622758 |
2012 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2012 401k financial data |
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Total income from all sources (including contributions) | 2012-12-31 | $402,484 |
Total of all expenses incurred | 2012-12-31 | $151,653 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $150,384 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $187,167 |
Value of total assets at end of year | 2012-12-31 | $2,983,277 |
Value of total assets at beginning of year | 2012-12-31 | $2,732,446 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $1,269 |
Total interest from all sources | 2012-12-31 | $22,130 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
Value of fidelity bond cover | 2012-12-31 | $500,000 |
If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
Funding deficiency by the employer to the plan for this plan year | 2012-12-31 | $0 |
Minimum employer required contribution for this plan year | 2012-12-31 | $62,430 |
Amount contributed by the employer to the plan for this plan year | 2012-12-31 | $62,430 |
Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
Contributions received from participants | 2012-12-31 | $101,325 |
Participant contributions at end of year | 2012-12-31 | $4,125 |
Participant contributions at beginning of year | 2012-12-31 | $4,165 |
Assets. Other investments not covered elsewhere at end of year | 2012-12-31 | $19,010 |
Assets. Other investments not covered elsewhere at beginning of year | 2012-12-31 | $16,721 |
Income. Received or receivable in cash from other sources (including rollovers) | 2012-12-31 | $23,412 |
Other income not declared elsewhere | 2012-12-31 | $2,319 |
Administrative expenses (other) incurred | 2012-12-31 | $1,269 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
Value of net income/loss | 2012-12-31 | $250,831 |
Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $2,983,277 |
Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $2,732,446 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
Value of interest in pooled separate accounts at end of year | 2012-12-31 | $1,632,973 |
Value of interest in pooled separate accounts at beginning of year | 2012-12-31 | $1,456,768 |
Interest earned on other investments | 2012-12-31 | $22,130 |
Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2012-12-31 | $1,291,458 |
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2012-12-31 | $1,230,629 |
Net investment gain/loss from pooled separate accounts | 2012-12-31 | $190,868 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | Yes |
Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
Contributions received in cash from employer | 2012-12-31 | $62,430 |
Employer contributions (assets) at end of year | 2012-12-31 | $35,711 |
Employer contributions (assets) at beginning of year | 2012-12-31 | $24,163 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $150,384 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
Did the plan have assets held for investment | 2012-12-31 | 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 | 2012-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | Yes |
Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Disclaimer |
Accountancy firm name | 2012-12-31 | MAHER DUESSEL, CPAS |
Accountancy firm EIN | 2012-12-31 | 251622758 |
2011 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2011 401k financial data |
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Total income from all sources (including contributions) | 2011-12-31 | $246,237 |
Total of all expenses incurred | 2011-12-31 | $625,078 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $623,928 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $282,359 |
Value of total assets at end of year | 2011-12-31 | $2,732,446 |
Value of total assets at beginning of year | 2011-12-31 | $3,111,287 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $1,150 |
Total interest from all sources | 2011-12-31 | $26,017 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
Value of fidelity bond cover | 2011-12-31 | $500,000 |
If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
Funding deficiency by the employer to the plan for this plan year | 2011-12-31 | $0 |
Minimum employer required contribution for this plan year | 2011-12-31 | $197,472 |
Amount contributed by the employer to the plan for this plan year | 2011-12-31 | $197,472 |
Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
Contributions received from participants | 2011-12-31 | $84,887 |
Participant contributions at end of year | 2011-12-31 | $4,165 |
Participant contributions at beginning of year | 2011-12-31 | $3,286 |
Assets. Other investments not covered elsewhere at end of year | 2011-12-31 | $16,721 |
Assets. Other investments not covered elsewhere at beginning of year | 2011-12-31 | $233,813 |
Other income not declared elsewhere | 2011-12-31 | $-4,821 |
Administrative expenses (other) incurred | 2011-12-31 | $1,150 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
Value of net income/loss | 2011-12-31 | $-378,841 |
Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $2,732,446 |
Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $3,111,287 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
Value of interest in pooled separate accounts at end of year | 2011-12-31 | $1,456,768 |
Value of interest in pooled separate accounts at beginning of year | 2011-12-31 | $1,563,139 |
Interest earned on other investments | 2011-12-31 | $26,017 |
Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2011-12-31 | $1,230,629 |
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2011-12-31 | $1,289,336 |
Net investment gain/loss from pooled separate accounts | 2011-12-31 | $-57,318 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | Yes |
Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
Contributions received in cash from employer | 2011-12-31 | $197,472 |
Employer contributions (assets) at end of year | 2011-12-31 | $24,163 |
Employer contributions (assets) at beginning of year | 2011-12-31 | $21,713 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $623,928 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
Did the plan have assets held for investment | 2011-12-31 | 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 | 2011-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | Yes |
Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Disclaimer |
Accountancy firm name | 2011-12-31 | MAHER DUESSEL, CPAS |
Accountancy firm EIN | 2011-12-31 | 251622758 |
2010 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2010 401k financial data |
---|
Total income from all sources (including contributions) | 2010-12-31 | $608,472 |
Total of all expenses incurred | 2010-12-31 | $368,635 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $367,815 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $343,784 |
Value of total assets at end of year | 2010-12-31 | $3,111,287 |
Value of total assets at beginning of year | 2010-12-31 | $2,871,450 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $820 |
Total interest from all sources | 2010-12-31 | $44,819 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
Value of fidelity bond cover | 2010-12-31 | $500,000 |
If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
Funding deficiency by the employer to the plan for this plan year | 2010-12-31 | $0 |
Minimum employer required contribution for this plan year | 2010-12-31 | $243,250 |
Amount contributed by the employer to the plan for this plan year | 2010-12-31 | $243,250 |
Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
Contributions received from participants | 2010-12-31 | $88,220 |
Participant contributions at end of year | 2010-12-31 | $3,286 |
Participant contributions at beginning of year | 2010-12-31 | $4,700 |
Assets. Other investments not covered elsewhere at end of year | 2010-12-31 | $233,813 |
Assets. Other investments not covered elsewhere at beginning of year | 2010-12-31 | $223,180 |
Income. Received or receivable in cash from other sources (including rollovers) | 2010-12-31 | $12,314 |
Administrative expenses (other) incurred | 2010-12-31 | $820 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
Value of net income/loss | 2010-12-31 | $239,837 |
Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $3,111,287 |
Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $2,871,450 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
Value of interest in pooled separate accounts at end of year | 2010-12-31 | $1,563,139 |
Value of interest in pooled separate accounts at beginning of year | 2010-12-31 | $1,328,504 |
Interest earned on other investments | 2010-12-31 | $44,819 |
Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2010-12-31 | $1,289,336 |
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2010-12-31 | $1,252,420 |
Net investment gain/loss from pooled separate accounts | 2010-12-31 | $219,869 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | Yes |
Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
Contributions received in cash from employer | 2010-12-31 | $243,250 |
Employer contributions (assets) at end of year | 2010-12-31 | $21,713 |
Employer contributions (assets) at beginning of year | 2010-12-31 | $62,646 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $367,815 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
Did the plan have assets held for investment | 2010-12-31 | 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 | 2010-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | Yes |
Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Disclaimer |
Accountancy firm name | 2010-12-31 | MAHER DUESSEL, CPAS |
Accountancy firm EIN | 2010-12-31 | 251622758 |
2009 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2009 401k financial data |
---|
Funding deficiency by the employer to the plan for this plan year | 2009-12-31 | $0 |
Minimum employer required contribution for this plan year | 2009-12-31 | $103,996 |
Amount contributed by the employer to the plan for this plan year | 2009-12-31 | $103,996 |
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 01755889 |
Policy instance | 5 |
Insurance contract or identification number | 01755889 | Number of Individuals Covered | 132 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $18,238 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $700,876 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,238 | Insurance broker organization code? | 3 | Insurance broker name | SIMPSON MCCRADY BENEFITS LLC |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05995918 |
Policy instance | 4 |
Insurance contract or identification number | TM05995918 | Number of Individuals Covered | 70 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $346 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $2,295 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $346 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NATIONAL INS. AGENCY, LLC |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 3316 |
Policy instance | 3 |
Insurance contract or identification number | 3316 | Number of Individuals Covered | 76 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 16011 |
Policy instance | 2 |
Insurance contract or identification number | 16011 | Number of Individuals Covered | 172 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,482 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 ) |
Policy contract number | 050318-F |
Policy instance | 1 |
Insurance contract or identification number | 050318-F | Number of Individuals Covered | 134 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $135 | Contracts With Unallocated Funds Deposit Administration | 1 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 135 | Additional information about fees paid to insurance broker | PORTION OF INCENTIVE COMP. PROGRAM | Insurance broker organization code? | 3 | Insurance broker name | PITTSBURGH REGIONAL OFFICE |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05995918 |
Policy instance | 4 |
Insurance contract or identification number | TM05995918 | Number of Individuals Covered | 82 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $573 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $3,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $573 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NATIONAL INS. AGENCY, LLC |
|
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 ) |
Policy contract number | 050318-F |
Policy instance | 1 |
Insurance contract or identification number | 050318-F | Number of Individuals Covered | 145 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $119 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 1 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 119 | Additional information about fees paid to insurance broker | PORTION OF INCENTIVE COMP. PROGRAM | Insurance broker organization code? | 3 | Insurance broker name | PITTSBURGH REGIONAL OFFICE |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 3316 |
Policy instance | 3 |
Insurance contract or identification number | 3316 | Number of Individuals Covered | 83 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
Policy contract number | ERLL14100720003 |
Policy instance | 5 |
Insurance contract or identification number | ERLL14100720003 | Number of Individuals Covered | 0 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $28,783 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $287,830 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,783 | Insurance broker organization code? | 3 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Amount paid for insurance broker fees | 0 | Insurance broker name | SIMPSON MCCRADY BENEFITS, LLC |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 16011 |
Policy instance | 2 |
Insurance contract or identification number | 16011 | Number of Individuals Covered | 143 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $50,299 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 16011 |
Policy instance | 2 |
Insurance contract or identification number | 16011 | Number of Individuals Covered | 195 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $63,294 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 ) |
Policy contract number | 050318-F |
Policy instance | 1 |
Insurance contract or identification number | 050318-F | Number of Individuals Covered | 150 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $640 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 1 | 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 | 640 | Additional information about fees paid to insurance broker | PORTION OF INCENTIVE COMP. PROGRAM | Insurance broker organization code? | 3 | Insurance broker name | PITTSBURGH REGIONAL OFFICE |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 3316 |
Policy instance | 3 |
Insurance contract or identification number | 3316 | Number of Individuals Covered | 111 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05995918 |
Policy instance | 4 |
Insurance contract or identification number | TM05995918 | Number of Individuals Covered | 99 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $675 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $4,847 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $675 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NATIONAL INS AGENCY LLC |
|
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
Policy contract number | ERLL13100720002 |
Policy instance | 5 |
Insurance contract or identification number | ERLL13100720002 | Number of Individuals Covered | 96 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $30,000 | Total amount of fees paid to insurance company | USD $3,012 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $300,003 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,000 | Amount paid for insurance broker fees | 3012 | Additional information about fees paid to insurance broker | ADDITIONAL INSURANCE COMMISSIONS PAID | Insurance broker organization code? | 3 | Insurance broker name | SIMPSON MCCRADY BENEFITS, LLC |
|
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 ) |
Policy contract number | 050318-F |
Policy instance | 1 |
Insurance contract or identification number | 050318-F | Number of Individuals Covered | 157 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $303 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 1 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 94 | Insurance broker organization code? | 3 | Insurance broker name | DAVID HOLETS |
|
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
Policy contract number | ERLL12100720001 |
Policy instance | 10 |
Insurance contract or identification number | ERLL12100720001 | Number of Individuals Covered | 103 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $21,781 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $181,504 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,781 | Insurance broker name | SIMPSON MCCRADY BENEFITS, LLC |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00399498 |
Policy instance | 2 |
Insurance contract or identification number | 00399498 | Number of Individuals Covered | 120 | Insurance policy start date | 2011-12-01 | Insurance policy end date | 2012-10-31 | Total amount of commissions paid to insurance broker | USD $1,247 | Total amount of fees paid to insurance company | USD $664 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,144 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,247 | Amount paid for insurance broker fees | 664 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
|
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
Policy contract number | 259335-070,2593 |
Policy instance | 3 |
Insurance contract or identification number | 259335-070,2593 | Number of Individuals Covered | 259 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $822 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,989 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $822 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
|
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 1256200 |
Policy instance | 4 |
Insurance contract or identification number | 1256200 | Number of Individuals Covered | 0 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $20,501 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $512,526 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,501 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
|
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 1256300 |
Policy instance | 5 |
Insurance contract or identification number | 1256300 | Number of Individuals Covered | 0 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $4,849 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $121,221 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,849 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
|
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 5524202 |
Policy instance | 6 |
Insurance contract or identification number | 5524202 | Number of Individuals Covered | 0 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $272 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,074 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $272 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 16011 |
Policy instance | 7 |
Insurance contract or identification number | 16011 | Number of Individuals Covered | 242 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 3316 |
Policy instance | 8 |
Insurance contract or identification number | 3316 | Number of Individuals Covered | 119 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05995918 |
Policy instance | 9 |
Insurance contract or identification number | TM05995918 | Number of Individuals Covered | 131 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $70 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $473 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $70 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NATIONAL INS AGENCY LLC |
|
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 1256300 |
Policy instance | 5 |
Insurance contract or identification number | 1256300 | Number of Individuals Covered | 289 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $10,303 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $257,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 1256200 |
Policy instance | 4 |
Insurance contract or identification number | 1256200 | Number of Individuals Covered | 289 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $43,820 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $1,088,986 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
Policy contract number | 259335-070,2593 |
Policy instance | 3 |
Insurance contract or identification number | 259335-070,2593 | Number of Individuals Covered | 253 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $1,726 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $57,391 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00399498 |
Policy instance | 2 |
Insurance contract or identification number | 00399498 | Number of Individuals Covered | 190 | Insurance policy start date | 2010-12-01 | Insurance policy end date | 2011-11-30 | Total amount of commissions paid to insurance broker | USD $1,416 | Total amount of fees paid to insurance company | USD $577 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $10,655 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 ) |
Policy contract number | 050318-F |
Policy instance | 1 |
Insurance contract or identification number | 050318-F | Number of Individuals Covered | 178 | Insurance policy start date | 2010-12-01 | Insurance policy end date | 2011-11-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $449 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 1 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 5524202 |
Policy instance | 6 |
Insurance contract or identification number | 5524202 | Number of Individuals Covered | 301 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $478 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 5524202 |
Policy instance | 6 |
Insurance contract or identification number | 5524202 | Number of Individuals Covered | 310 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $529 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,628 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $529 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 1256300 |
Policy instance | 5 |
Insurance contract or identification number | 1256300 | Number of Individuals Covered | 299 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $11,742 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $293,384 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,742 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 1256200 |
Policy instance | 4 |
Insurance contract or identification number | 1256200 | Number of Individuals Covered | 299 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $40,695 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $1,016,770 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,695 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
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UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
Policy contract number | 259335-070,2593 |
Policy instance | 3 |
Insurance contract or identification number | 259335-070,2593 | Number of Individuals Covered | 264 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $1,713 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $57,787 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,713 | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
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MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 ) |
Policy contract number | 050318-F |
Policy instance | 1 |
Insurance contract or identification number | 050318-F | Number of Individuals Covered | 173 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $3,020 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 1 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1010 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | JOHN C. HILZENDEGER |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00399498 |
Policy instance | 2 |
Insurance contract or identification number | 00399498 | Number of Individuals Covered | 162 | Insurance policy start date | 2009-12-01 | Insurance policy end date | 2010-11-30 | Total amount of commissions paid to insurance broker | USD $1,273 | Total amount of fees paid to insurance company | USD $591 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,360 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,273 | Amount paid for insurance broker fees | 591 | Additional information about fees paid to insurance broker | COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | DAVEVIC BENEFIT CONSULTANTS |
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