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403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 401k Plan overview

Plan Name403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER
Plan identification number 002

403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision

401k Sponsoring company profile

IRENE STACY COMMUNITY MENTAL HEALTH CENTER has sponsored the creation of one or more 401k plans.

Company Name:IRENE STACY COMMUNITY MENTAL HEALTH CENTER
Employer identification number (EIN):251069977
NAIC Classification:621420
NAIC Description:Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022017-01-01
0022016-01-01
0022015-01-01
0022014-01-01
0022013-01-01
0022012-01-01NATALIE ROSS
0022011-01-01STEVE LAUBACHER
0022010-01-01ROGER KELLY
0022009-01-01ROGER KELLY

Plan Statistics for 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
2017: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2017 401k membership
Total participants, beginning-of-year2017-01-0195
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-010
Number of participants with account balances2017-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2016 401k membership
Total participants, beginning-of-year2016-01-01134
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0194
Total of all active and inactive participants2016-01-0194
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-011
Total participants2016-01-0195
Number of participants with account balances2016-01-0194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0124
2015: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2015 401k membership
Total participants, beginning-of-year2015-01-01145
Total number of active participants reported on line 7a of the Form 55002015-01-0144
Number of other retired or separated participants entitled to future benefits2015-01-0178
Total of all active and inactive participants2015-01-01122
Total participants2015-01-01122
Number of participants with account balances2015-01-01134
2014: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2014 401k membership
Total participants, beginning-of-year2014-01-01150
Total number of active participants reported on line 7a of the Form 55002014-01-0165
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0180
Total of all active and inactive participants2014-01-01145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01145
Number of participants with account balances2014-01-01145
2013: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2013 401k membership
Total participants, beginning-of-year2013-01-01157
Total number of active participants reported on line 7a of the Form 55002013-01-0191
Number of other retired or separated participants entitled to future benefits2013-01-0159
Total of all active and inactive participants2013-01-01150
Total participants2013-01-01150
Number of participants with account balances2013-01-01150
2012: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2012 401k membership
Total participants, beginning-of-year2012-01-01178
Total number of active participants reported on line 7a of the Form 55002012-01-01111
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0146
Total of all active and inactive participants2012-01-01157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01157
Number of participants with account balances2012-01-01157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2011 401k membership
Total participants, beginning-of-year2011-01-01173
Total number of active participants reported on line 7a of the Form 55002011-01-01150
Number of retired or separated participants receiving benefits2011-01-0127
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01177
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-01178
Number of participants with account balances2011-01-01177
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2010 401k membership
Total participants, beginning-of-year2010-01-01163
Total number of active participants reported on line 7a of the Form 55002010-01-01153
Number of other retired or separated participants entitled to future benefits2010-01-0120
Total of all active and inactive participants2010-01-01173
Total participants2010-01-01173
Number of participants with account balances2010-01-01173
2009: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2009 401k membership
Total participants, beginning-of-year2009-01-01147
Total number of active participants reported on line 7a of the Form 55002009-01-01138
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-017
Total of all active and inactive participants2009-01-01145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01145
Number of participants with account balances2009-01-01145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER

Measure Date Value
2017 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2017 401k financial data
Total income from all sources2017-08-31$86,698
Expenses. Total of all expenses incurred2017-08-31$1,266,189
Benefits paid (including direct rollovers)2017-08-31$1,231,780
Total plan assets at end of year2017-08-31$0
Total plan assets at beginning of year2017-08-31$1,179,491
Total contributions received or receivable from participants2017-08-31$0
Assets. Value of loans (other than to participants)2017-08-31$0
Expenses. Other expenses not covered elsewhere2017-08-31$34,409
Other income received2017-08-31$86,698
Net income (gross income less expenses)2017-08-31$-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 securities2017-08-31$0
2016 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$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 assets2016-12-31$0
Total of all expenses incurred2016-12-31$632,131
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$631,381
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$0
Value of total assets at end of year2016-12-31$1,179,491
Value of total assets at beginning of year2016-12-31$1,762,921
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$750
Total interest from all sources2016-12-31$48,701
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31No
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Participant contributions at beginning of year2016-12-31$1,755
Administrative expenses (other) incurred2016-12-31$750
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-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)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in pooled separate accounts at end of year2016-12-31$621,421
Value of interest in pooled separate accounts at beginning of year2016-12-31$1,014,775
Interest earned on other investments2016-12-31$48,701
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$558,070
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$746,391
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$631,381
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31LAW OFFICE OF MATTHEW J. BORROR
Accountancy firm EIN2016-12-31272898041
2015 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2015 401k financial data
Total income from all sources (including contributions)2015-12-31$68,659
Total of all expenses incurred2015-12-31$743,160
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$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 year2015-12-31$1,762,921
Value of total assets at beginning of year2015-12-31$2,437,422
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$1,130
Total interest from all sources2015-12-31$10,324
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31No
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$59,062
Participant contributions at end of year2015-12-31$1,755
Participant contributions at beginning of year2015-12-31$5,639
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$4,130
Administrative expenses (other) incurred2015-12-31$1,130
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-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)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in pooled separate accounts at end of year2015-12-31$1,014,775
Value of interest in pooled separate accounts at beginning of year2015-12-31$1,554,023
Interest earned on other investments2015-12-31$10,324
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$746,391
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$841,690
Net investment gain/loss from pooled separate accounts2015-12-31$-4,857
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31Yes
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Employer contributions (assets) at beginning of year2015-12-31$36,070
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$742,030
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31MAHER DUESSEL, CPAS
Accountancy firm EIN2015-12-31251622758
2014 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2014 401k financial data
Total income from all sources (including contributions)2014-12-31$309,556
Total of all expenses incurred2014-12-31$678,382
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$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 year2014-12-31$2,437,422
Value of total assets at beginning of year2014-12-31$2,806,248
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$1,182
Total interest from all sources2014-12-31$11,610
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$1,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Funding deficiency by the employer to the plan for this plan year2014-12-31$0
Minimum employer required contribution for this plan year2014-12-31$44,799
Amount contributed by the employer to the plan for this plan year2014-12-31$44,799
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$81,952
Participant contributions at end of year2014-12-31$5,639
Participant contributions at beginning of year2014-12-31$3,823
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$63,862
Administrative expenses (other) incurred2014-12-31$1,182
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-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)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in pooled separate accounts at end of year2014-12-31$1,554,023
Value of interest in pooled separate accounts at beginning of year2014-12-31$1,729,905
Interest earned on other investments2014-12-31$11,610
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$841,690
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$1,039,973
Net investment gain/loss from pooled separate accounts2014-12-31$107,333
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31Yes
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$44,799
Employer contributions (assets) at end of year2014-12-31$36,070
Employer contributions (assets) at beginning of year2014-12-31$32,547
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$677,200
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31MAHER DUESSEL, CPAS
Accountancy firm EIN2014-12-31251622758
2013 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2013 401k financial data
Total income from all sources (including contributions)2013-12-31$539,998
Total of all expenses incurred2013-12-31$717,027
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$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 year2013-12-31$2,806,248
Value of total assets at beginning of year2013-12-31$2,983,277
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$1,168
Total interest from all sources2013-12-31$15,425
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$1,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Funding deficiency by the employer to the plan for this plan year2013-12-31$0
Minimum employer required contribution for this plan year2013-12-31$42,387
Amount contributed by the employer to the plan for this plan year2013-12-31$42,387
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$66,380
Participant contributions at end of year2013-12-31$3,823
Participant contributions at beginning of year2013-12-31$4,125
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$19,010
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$67,059
Other income not declared elsewhere2013-12-31$2,577
Administrative expenses (other) incurred2013-12-31$1,168
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-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)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in pooled separate accounts at end of year2013-12-31$1,729,905
Value of interest in pooled separate accounts at beginning of year2013-12-31$1,632,973
Interest earned on other investments2013-12-31$15,425
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$1,039,973
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$1,291,458
Net investment gain/loss from pooled separate accounts2013-12-31$346,170
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31Yes
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$42,387
Employer contributions (assets) at end of year2013-12-31$32,547
Employer contributions (assets) at beginning of year2013-12-31$35,711
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$715,859
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31MAHER DUESSEL, CPAS
Accountancy firm EIN2013-12-31251622758
2012 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2012 401k financial data
Total income from all sources (including contributions)2012-12-31$402,484
Total of all expenses incurred2012-12-31$151,653
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$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 year2012-12-31$2,983,277
Value of total assets at beginning of year2012-12-31$2,732,446
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$1,269
Total interest from all sources2012-12-31$22,130
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$62,430
Amount contributed by the employer to the plan for this plan year2012-12-31$62,430
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$101,325
Participant contributions at end of year2012-12-31$4,125
Participant contributions at beginning of year2012-12-31$4,165
Assets. Other investments not covered elsewhere at end of year2012-12-31$19,010
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$16,721
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$23,412
Other income not declared elsewhere2012-12-31$2,319
Administrative expenses (other) incurred2012-12-31$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 appraiser2012-12-31No
Value of net income/loss2012-12-31$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)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in pooled separate accounts at end of year2012-12-31$1,632,973
Value of interest in pooled separate accounts at beginning of year2012-12-31$1,456,768
Interest earned on other investments2012-12-31$22,130
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$1,291,458
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$1,230,629
Net investment gain/loss from pooled separate accounts2012-12-31$190,868
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31Yes
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$62,430
Employer contributions (assets) at end of year2012-12-31$35,711
Employer contributions (assets) at beginning of year2012-12-31$24,163
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$150,384
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31MAHER DUESSEL, CPAS
Accountancy firm EIN2012-12-31251622758
2011 : 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2011 401k financial data
Total income from all sources (including contributions)2011-12-31$246,237
Total of all expenses incurred2011-12-31$625,078
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$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 year2011-12-31$2,732,446
Value of total assets at beginning of year2011-12-31$3,111,287
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$1,150
Total interest from all sources2011-12-31$26,017
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Funding deficiency by the employer to the plan for this plan year2011-12-31$0
Minimum employer required contribution for this plan year2011-12-31$197,472
Amount contributed by the employer to the plan for this plan year2011-12-31$197,472
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$84,887
Participant contributions at end of year2011-12-31$4,165
Participant contributions at beginning of year2011-12-31$3,286
Assets. Other investments not covered elsewhere at end of year2011-12-31$16,721
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$233,813
Other income not declared elsewhere2011-12-31$-4,821
Administrative expenses (other) incurred2011-12-31$1,150
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-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)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in pooled separate accounts at end of year2011-12-31$1,456,768
Value of interest in pooled separate accounts at beginning of year2011-12-31$1,563,139
Interest earned on other investments2011-12-31$26,017
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$1,230,629
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$1,289,336
Net investment gain/loss from pooled separate accounts2011-12-31$-57,318
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31Yes
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$197,472
Employer contributions (assets) at end of year2011-12-31$24,163
Employer contributions (assets) at beginning of year2011-12-31$21,713
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$623,928
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31MAHER DUESSEL, CPAS
Accountancy firm EIN2011-12-31251622758
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 incurred2010-12-31$368,635
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$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 year2010-12-31$3,111,287
Value of total assets at beginning of year2010-12-31$2,871,450
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$820
Total interest from all sources2010-12-31$44,819
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Funding deficiency by the employer to the plan for this plan year2010-12-31$0
Minimum employer required contribution for this plan year2010-12-31$243,250
Amount contributed by the employer to the plan for this plan year2010-12-31$243,250
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$88,220
Participant contributions at end of year2010-12-31$3,286
Participant contributions at beginning of year2010-12-31$4,700
Assets. Other investments not covered elsewhere at end of year2010-12-31$233,813
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$223,180
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$12,314
Administrative expenses (other) incurred2010-12-31$820
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$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)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in pooled separate accounts at end of year2010-12-31$1,563,139
Value of interest in pooled separate accounts at beginning of year2010-12-31$1,328,504
Interest earned on other investments2010-12-31$44,819
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$1,289,336
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$1,252,420
Net investment gain/loss from pooled separate accounts2010-12-31$219,869
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31Yes
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$243,250
Employer contributions (assets) at end of year2010-12-31$21,713
Employer contributions (assets) at beginning of year2010-12-31$62,646
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$367,815
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31MAHER DUESSEL, CPAS
Accountancy firm EIN2010-12-31251622758
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 year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$103,996
Amount contributed by the employer to the plan for this plan year2009-12-31$103,996

Form 5500 Responses for 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER

2017: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: 403(B) THRIFT PLAN FOR EMPLOYEES OF IRENE STACY COMMUNITY MENTAL HEALTH CENTER 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
2009-01-01This submission is the final filingNo
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01755889
Policy instance 5
Insurance contract or identification number01755889
Number of Individuals Covered132
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $18,238
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $700,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,238
Insurance broker organization code?3
Insurance broker nameSIMPSON MCCRADY BENEFITS LLC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05995918
Policy instance 4
Insurance contract or identification numberTM05995918
Number of Individuals Covered70
Insurance policy start date2015-01-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $346
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $346
Insurance broker organization code?3
Insurance broker nameFIRST NATIONAL INS. AGENCY, LLC
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number3316
Policy instance 3
Insurance contract or identification number3316
Number of Individuals Covered76
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
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 number16011
Policy instance 2
Insurance contract or identification number16011
Number of Individuals Covered172
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number050318-F
Policy instance 1
Insurance contract or identification number050318-F
Number of Individuals Covered134
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $135
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees135
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker namePITTSBURGH REGIONAL OFFICE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05995918
Policy instance 4
Insurance contract or identification numberTM05995918
Number of Individuals Covered82
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $573
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $573
Insurance broker organization code?3
Insurance broker nameFIRST NATIONAL INS. AGENCY, LLC
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050318-F
Policy instance 1
Insurance contract or identification number050318-F
Number of Individuals Covered145
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $119
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees119
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker namePITTSBURGH REGIONAL OFFICE
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number3316
Policy instance 3
Insurance contract or identification number3316
Number of Individuals Covered83
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberERLL14100720003
Policy instance 5
Insurance contract or identification numberERLL14100720003
Number of Individuals Covered0
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $28,783
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $287,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,783
Insurance broker organization code?3
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Amount paid for insurance broker fees0
Insurance broker nameSIMPSON MCCRADY BENEFITS, LLC
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16011
Policy instance 2
Insurance contract or identification number16011
Number of Individuals Covered143
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number16011
Policy instance 2
Insurance contract or identification number16011
Number of Individuals Covered195
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number050318-F
Policy instance 1
Insurance contract or identification number050318-F
Number of Individuals Covered150
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $640
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees640
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker namePITTSBURGH REGIONAL OFFICE
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number3316
Policy instance 3
Insurance contract or identification number3316
Number of Individuals Covered111
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
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 numberTM05995918
Policy instance 4
Insurance contract or identification numberTM05995918
Number of Individuals Covered99
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $675
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $4,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $675
Insurance broker organization code?3
Insurance broker nameFIRST NATIONAL INS AGENCY LLC
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberERLL13100720002
Policy instance 5
Insurance contract or identification numberERLL13100720002
Number of Individuals Covered96
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $30,000
Total amount of fees paid to insurance companyUSD $3,012
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $300,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,000
Amount paid for insurance broker fees3012
Additional information about fees paid to insurance brokerADDITIONAL INSURANCE COMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameSIMPSON MCCRADY BENEFITS, LLC
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050318-F
Policy instance 1
Insurance contract or identification number050318-F
Number of Individuals Covered157
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $303
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees94
Insurance broker organization code?3
Insurance broker nameDAVID HOLETS
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberERLL12100720001
Policy instance 10
Insurance contract or identification numberERLL12100720001
Number of Individuals Covered103
Insurance policy start date2012-07-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $21,781
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $181,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,781
Insurance broker nameSIMPSON MCCRADY BENEFITS, LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00399498
Policy instance 2
Insurance contract or identification number00399498
Number of Individuals Covered120
Insurance policy start date2011-12-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $1,247
Total amount of fees paid to insurance companyUSD $664
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,247
Amount paid for insurance broker fees664
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number259335-070,2593
Policy instance 3
Insurance contract or identification number259335-070,2593
Number of Individuals Covered259
Insurance policy start date2012-01-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $822
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $822
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number1256200
Policy instance 4
Insurance contract or identification number1256200
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $20,501
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $512,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,501
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number1256300
Policy instance 5
Insurance contract or identification number1256300
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,849
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $121,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,849
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number5524202
Policy instance 6
Insurance contract or identification number5524202
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $272
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $272
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16011
Policy instance 7
Insurance contract or identification number16011
Number of Individuals Covered242
Insurance policy start date2012-08-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number3316
Policy instance 8
Insurance contract or identification number3316
Number of Individuals Covered119
Insurance policy start date2012-08-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberTM05995918
Policy instance 9
Insurance contract or identification numberTM05995918
Number of Individuals Covered131
Insurance policy start date2012-11-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $70
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70
Insurance broker organization code?3
Insurance broker nameFIRST NATIONAL INS AGENCY LLC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number1256300
Policy instance 5
Insurance contract or identification number1256300
Number of Individuals Covered289
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,303
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 number1256200
Policy instance 4
Insurance contract or identification number1256200
Number of Individuals Covered289
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $43,820
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 number259335-070,2593
Policy instance 3
Insurance contract or identification number259335-070,2593
Number of Individuals Covered253
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,726
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number00399498
Policy instance 2
Insurance contract or identification number00399498
Number of Individuals Covered190
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $1,416
Total amount of fees paid to insurance companyUSD $577
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 number050318-F
Policy instance 1
Insurance contract or identification number050318-F
Number of Individuals Covered178
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $449
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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 number5524202
Policy instance 6
Insurance contract or identification number5524202
Number of Individuals Covered301
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $478
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,934
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 number5524202
Policy instance 6
Insurance contract or identification number5524202
Number of Individuals Covered310
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $529
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $529
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number1256300
Policy instance 5
Insurance contract or identification number1256300
Number of Individuals Covered299
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $11,742
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $293,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,742
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number1256200
Policy instance 4
Insurance contract or identification number1256200
Number of Individuals Covered299
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $40,695
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $40,695
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number259335-070,2593
Policy instance 3
Insurance contract or identification number259335-070,2593
Number of Individuals Covered264
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,713
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,713
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050318-F
Policy instance 1
Insurance contract or identification number050318-F
Number of Individuals Covered173
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,020
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1010
Additional information about fees paid to insurance brokerCOMPENSATION
Insurance broker organization code?3
Insurance broker nameJOHN C. HILZENDEGER
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00399498
Policy instance 2
Insurance contract or identification number00399498
Number of Individuals Covered162
Insurance policy start date2009-12-01
Insurance policy end date2010-11-30
Total amount of commissions paid to insurance brokerUSD $1,273
Total amount of fees paid to insurance companyUSD $591
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,273
Amount paid for insurance broker fees591
Additional information about fees paid to insurance brokerCOMPENSATION
Insurance broker organization code?3
Insurance broker nameDAVEVIC BENEFIT CONSULTANTS

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