401k Plan data: MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM plan

MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM 401k Plan overview

Plan Name	MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM
Plan identification number	502

MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

MID COLUMBIA CHILDREN'S COUNCIL has sponsored the creation of one or more 401k plans.

Company Name: MID COLUMBIA CHILDREN'S COUNCIL

Employer identification number (EIN): 930951908

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01 FREDDY GONZALEZ 2023-07-12
502 2021-01-01 PAUL RUNYON 2022-07-25
502 2020-01-01 PAUL RUNYON 2021-10-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2022-01-01	FREDDY GONZALEZ	2023-07-12
502	2021-01-01	PAUL RUNYON	2022-07-25
502	2020-01-01	PAUL RUNYON	2021-10-07

Form 5500 Responses for MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM

2022: MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: MID COLUMBIA CHILDRENS COUNCIL EMPLOYEE HEALTH AND WELFARE PROGRAM 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

755631

Policy instance

Insurance contract or identification number	755631
Number of Individuals Covered	83
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,643
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

30305

Policy instance

Insurance contract or identification number	30305
Number of Individuals Covered	87
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $356
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5287230

Policy instance

Insurance contract or identification number	E5287230
Number of Individuals Covered	64
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,252
Total amount of fees paid to insurance company	USD $3,476
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $57,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

114395

Policy instance

Insurance contract or identification number	114395
Number of Individuals Covered	86
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $762,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

755631

Policy instance

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

30305

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5287230

Policy instance

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

114395

Policy instance

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

755631

Policy instance

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

30305

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5287230

Policy instance

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

114395

Policy instance

Potentially related plans

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Company Name:	MID COLUMBIA CHILDREN'S COUNCIL
Employer identification number (EIN):	930951908
NAIC Classification:	624100
NAIC Description:	Individual and Family Services