401k Plan data: THE ARC OF MONMOUTH, INC., WELFARE PLAN plan

THE ARC OF MONMOUTH, INC., WELFARE PLAN 401k Plan overview

Plan Name	THE ARC OF MONMOUTH, INC., WELFARE PLAN
Plan identification number	501

THE ARC OF MONMOUTH, INC., WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

THE ARC OF MONMOUTH, INC. has sponsored the creation of one or more 401k plans.

Company Name: THE ARC OF MONMOUTH, INC.

Employer identification number (EIN): 210657022

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE ARC OF MONMOUTH, INC., WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-07-01
501 2019-07-01
501 2018-07-01
501 2017-07-01 ROBERT ANGEL 2019-06-06
501 2016-07-01
501 2015-07-01 LINDA MAYO LINDA MAYO 2017-01-26
501 2014-07-01 MARY E. SCOTT MARY E. SCOTT 2016-01-13
501 2013-07-01 MARY E. SCOTT MARY E. SCOTT 2015-01-05
501 2012-07-01 MARY E. SCOTT MARY E. SCOTT 2014-03-17
501 2011-07-01 MARY E. SCOTT MARY E. SCOTT 2013-01-31
501 2009-07-01 MARY E. SCOTT
501 2009-07-01 MARY E. SCOTT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-07-01
501	2019-07-01
501	2018-07-01
501	2017-07-01	ROBERT ANGEL	2019-06-06
501	2016-07-01
501	2015-07-01	LINDA MAYO		LINDA MAYO	2017-01-26
501	2014-07-01	MARY E. SCOTT		MARY E. SCOTT	2016-01-13
501	2013-07-01	MARY E. SCOTT		MARY E. SCOTT	2015-01-05
501	2012-07-01	MARY E. SCOTT		MARY E. SCOTT	2014-03-17
501	2011-07-01	MARY E. SCOTT		MARY E. SCOTT	2013-01-31
501	2009-07-01	MARY E. SCOTT
501	2009-07-01	MARY E. SCOTT

Plan Statistics for THE ARC OF MONMOUTH, INC., WELFARE PLAN

401k plan membership statisitcs for THE ARC OF MONMOUTH, INC., WELFARE PLAN

Measure Date Value
2021: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 136
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 122
Number of retired or separated participants receiving benefits 2021-07-01 5
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 127
2019: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 151
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 136
Number of retired or separated participants receiving benefits 2019-07-01 9
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 145
2018: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 180
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 142
Number of retired or separated participants receiving benefits 2018-07-01 5
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 147
2017: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 177
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 175
Total of all active and inactive participants 2017-07-01 175
Total participants 2017-07-01 175
2016: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 192
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 177
Total of all active and inactive participants 2016-07-01 177
Total participants 2016-07-01 177
2015: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 205
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 192
Total of all active and inactive participants 2015-07-01 192
Total participants 2015-07-01 192
2014: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 201
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 205
Total of all active and inactive participants 2014-07-01 205
Total participants 2014-07-01 205
2013: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 191
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 201
Total of all active and inactive participants 2013-07-01 201
Total participants 2013-07-01 201
2012: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 199
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 191
Total of all active and inactive participants 2012-07-01 191
Total participants 2012-07-01 191
2011: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 192
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 199
Total of all active and inactive participants 2011-07-01 199
Total participants 2011-07-01 199
2009: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 204
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 202
Total of all active and inactive participants 2009-07-01 202
Total participants 2009-07-01 202

Measure	Date	Value
2021: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	136
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	122
Number of retired or separated participants receiving benefits	2021-07-01	5
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	127
2019: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	151
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	136
Number of retired or separated participants receiving benefits	2019-07-01	9
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	145
2018: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	180
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	142
Number of retired or separated participants receiving benefits	2018-07-01	5
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	147
2017: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	177
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	175
Total of all active and inactive participants	2017-07-01	175
Total participants	2017-07-01	175
2016: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	192
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	177
Total of all active and inactive participants	2016-07-01	177
Total participants	2016-07-01	177
2015: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	205
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	192
Total of all active and inactive participants	2015-07-01	192
Total participants	2015-07-01	192
2014: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	201
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	205
Total of all active and inactive participants	2014-07-01	205
Total participants	2014-07-01	205
2013: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	191
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	201
Total of all active and inactive participants	2013-07-01	201
Total participants	2013-07-01	201
2012: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	199
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	191
Total of all active and inactive participants	2012-07-01	191
Total participants	2012-07-01	191
2011: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	192
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	199
Total of all active and inactive participants	2011-07-01	199
Total participants	2011-07-01	199
2009: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	204
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	202
Total of all active and inactive participants	2009-07-01	202
Total participants	2009-07-01	202

Form 5500 Responses for THE ARC OF MONMOUTH, INC., WELFARE PLAN

2021: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Submission has been amended	No
2021-07-01	This submission is the final filing	No
2021-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-07-01	Plan is a collectively bargained plan	No
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2019: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	No
2018-07-01	This submission is the final filing	No
2018-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-07-01	Plan is a collectively bargained plan	No
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2009: THE ARC OF MONMOUTH, INC., WELFARE PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	Yes
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	132
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,159
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $21,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,159
Insurance broker organization code?	3

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	142
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $2,147
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $40,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,795
Insurance broker organization code?	3

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	136
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $9,627
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $408,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,796
Insurance broker organization code?	3

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	136
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $34,283
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,631,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,339
Insurance broker organization code?	3

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	144
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $11,130
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $470,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,290
Insurance broker organization code?	3

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	149
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,132
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $45,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,193
Insurance broker organization code?	3

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	142
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $36,708
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,686,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,934
Insurance broker organization code?	3

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	167
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $11,500
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $487,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	165
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $31,344
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,706,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F016341

Policy instance

Insurance contract or identification number	F016341
Number of Individuals Covered	175
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $2,198
Total amount of fees paid to insurance company	USD $1,241
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $20,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD608032

Policy instance

Insurance contract or identification number	SGD608032
Number of Individuals Covered	79
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,103
Total amount of fees paid to insurance company	USD $448
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	176
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $2,259
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F016341

Policy instance

Insurance contract or identification number	F016341
Number of Individuals Covered	192
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,616
Total amount of fees paid to insurance company	USD $940
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $14,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,616
Amount paid for insurance broker fees	940
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00471691

Policy instance

Insurance contract or identification number	00471691
Number of Individuals Covered	79
Insurance policy start date	2015-10-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,353
Total amount of fees paid to insurance company	USD $1,210
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,352
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
Insurance broker organization code?	3
Amount paid for insurance broker fees	1210
Additional information about fees paid to insurance broker	FEES
Insurance broker name	WELLS FARGO INSURANCE SERVICES

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	174
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $40,858
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,407,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,858
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	174
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $13,199
Welfare Benefit Premiums Paid to Carrier	USD $503,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,199
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	183
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $2,537
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,537
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F016341

Policy instance

Insurance contract or identification number	F016341
Number of Individuals Covered	205
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,695
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $15,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,695
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00471691

Policy instance

Insurance contract or identification number	00471691
Number of Individuals Covered	78
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $1,628
Total amount of fees paid to insurance company	USD $1,105
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32
Insurance broker organization code?	3
Amount paid for insurance broker fees	1105
Additional information about fees paid to insurance broker	FEES
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	173
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $40,787
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,388,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,787
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	188
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $2,543
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,543
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	173
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $16,828
Welfare Benefit Premiums Paid to Carrier	USD $485,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,828
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	168
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $13,559
Welfare Benefit Premiums Paid to Carrier	USD $451,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,559
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	175
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $2,429
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,429
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F016341

Policy instance

Insurance contract or identification number	F016341
Number of Individuals Covered	201
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $1,627
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $14,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,627
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00471691

Policy instance

Insurance contract or identification number	00471691
Number of Individuals Covered	78
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $1,590
Total amount of fees paid to insurance company	USD $896
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31
Insurance broker organization code?	3
Amount paid for insurance broker fees	896
Additional information about fees paid to insurance broker	FEES
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	168
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $39,375
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,311,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,375
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F016341

Policy instance

Insurance contract or identification number	F016341
Number of Individuals Covered	191
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $1,579
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $14,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,579
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	163
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $38,544
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,284,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,544
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	163
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $13,189
Welfare Benefit Premiums Paid to Carrier	USD $439,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,189
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00471691

Policy instance

Insurance contract or identification number	00471691
Number of Individuals Covered	75
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $1,515
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,853
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
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	170
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,335
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,335
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES USA

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00471691

Policy instance

Insurance contract or identification number	00471691
Number of Individuals Covered	80
Insurance policy start date	2011-10-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $1,235
Total amount of fees paid to insurance company	USD $302
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F016341

Policy instance

Insurance contract or identification number	F016341
Number of Individuals Covered	199
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $1,640
Total amount of fees paid to insurance company	USD $547
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $14,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G00091J5

Policy instance

Insurance contract or identification number	G00091J5
Number of Individuals Covered	77
Insurance policy start date	2011-07-01
Insurance policy end date	2011-10-01
Total amount of commissions paid to insurance broker	USD $583
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	164
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $35,506
Health Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,188,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	164
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $13,066
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $435,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	182
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $2,619
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	167
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $12,454
Total amount of fees paid to insurance company	USD $0
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $415,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	178
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $2,409
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F016341

Policy instance

Insurance contract or identification number	F016341
Number of Individuals Covered	192
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $1,688
Total amount of fees paid to insurance company	USD $1,384
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $15,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G00091J5

Policy instance

Insurance contract or identification number	G00091J5
Number of Individuals Covered	77
Insurance policy start date	2010-07-01
Insurance policy end date	2011-07-01
Total amount of commissions paid to insurance broker	USD $2,559
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

87875

Policy instance

Insurance contract or identification number	87875
Number of Individuals Covered	163
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $35,298
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,171,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	THE ARC OF MONMOUTH, INC.
Employer identification number (EIN):	210657022
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations