401k Plan data: MEDICAL plan

MEDICAL 401k Plan overview

Plan Name	MEDICAL
Plan identification number	503

MEDICAL Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

COMMUNITY INTEGRATED SERVICES has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY INTEGRATED SERVICES

Employer identification number (EIN): 232648381

NAIC Classification: 624310
NAIC Description: Vocational Rehabilitation Services

Additional information about COMMUNITY INTEGRATED SERVICES

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3378077

More information about COMMUNITY INTEGRATED SERVICES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01 WENDY COWAN 2023-08-02
503 2021-01-01 WENDY COWAN 2022-09-28
503 2020-01-01 WENDY COWAN 2021-08-11
503 2019-01-01 WENDY COWAN 2020-06-23
503 2018-01-01 WENDY COWAN 2019-08-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2022-01-01	WENDY COWAN	2023-08-02
503	2021-01-01	WENDY COWAN	2022-09-28
503	2020-01-01	WENDY COWAN	2021-08-11
503	2019-01-01	WENDY COWAN	2020-06-23
503	2018-01-01	WENDY COWAN	2019-08-15

Plan Statistics for MEDICAL

401k plan membership statisitcs for MEDICAL

Measure Date Value
2022: MEDICAL 2022 401k membership
Total participants, beginning-of-year 2022-01-01 190
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 156
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 156
Number of employers contributing to the scheme 2022-01-01 0
2021: MEDICAL 2021 401k membership
Total participants, beginning-of-year 2021-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 190
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 190
Number of employers contributing to the scheme 2021-01-01 0
2020: MEDICAL 2020 401k membership
Total participants, beginning-of-year 2020-01-01 209
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 127
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 127
Number of employers contributing to the scheme 2020-01-01 0
2019: MEDICAL 2019 401k membership
Total participants, beginning-of-year 2019-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 103
Number of retired or separated participants receiving benefits 2019-01-01 103
Number of other retired or separated participants entitled to future benefits 2019-01-01 3
Total of all active and inactive participants 2019-01-01 209
Number of employers contributing to the scheme 2019-01-01 0
2018: MEDICAL 2018 401k membership
Total participants, beginning-of-year 2018-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 100
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 100
Number of employers contributing to the scheme 2018-01-01 0

Measure	Date	Value
2022: MEDICAL 2022 401k membership
Total participants, beginning-of-year	2022-01-01	190
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	156
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	156
Number of employers contributing to the scheme	2022-01-01	0
2021: MEDICAL 2021 401k membership
Total participants, beginning-of-year	2021-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	190
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	190
Number of employers contributing to the scheme	2021-01-01	0
2020: MEDICAL 2020 401k membership
Total participants, beginning-of-year	2020-01-01	209
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	127
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	127
Number of employers contributing to the scheme	2020-01-01	0
2019: MEDICAL 2019 401k membership
Total participants, beginning-of-year	2019-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	103
Number of retired or separated participants receiving benefits	2019-01-01	103
Number of other retired or separated participants entitled to future benefits	2019-01-01	3
Total of all active and inactive participants	2019-01-01	209
Number of employers contributing to the scheme	2019-01-01	0
2018: MEDICAL 2018 401k membership
Total participants, beginning-of-year	2018-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	100
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	100
Number of employers contributing to the scheme	2018-01-01	0

Form 5500 Responses for MEDICAL

2022: MEDICAL 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: MEDICAL 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: MEDICAL 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
2019: MEDICAL 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: MEDICAL 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	25
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,769
Total amount of fees paid to insurance company	USD $287
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,769
Amount paid for insurance broker fees	287
Additional information about fees paid to insurance broker	OVERRIDE/NON-MONETARY COMMISSIONS
Insurance broker organization code?	3

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
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 $19,512
Total amount of fees paid to insurance company	USD $953
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,512
Amount paid for insurance broker fees	953
Additional information about fees paid to insurance broker	OVERRIDE/NON-MONETARY COMMISSIONS
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	88
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $21,565
Total amount of fees paid to insurance company	USD $1,120
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,565
Amount paid for insurance broker fees	1120
Additional information about fees paid to insurance broker	OVERRIDE/NON-MONETARY COMMISSIONS
Insurance broker organization code?	3

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	37
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,662
Total amount of fees paid to insurance company	USD $399
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,662
Amount paid for insurance broker fees	399
Additional information about fees paid to insurance broker	OVERRIDE/NON-MONETARY COMPENSATION
Insurance broker organization code?	3

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	84
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $33,026
Total amount of fees paid to insurance company	USD $1,014
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,026
Amount paid for insurance broker fees	1014
Additional information about fees paid to insurance broker	OVERRIDE/NON-MONETARY COMPENSATION
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	69
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $33,957
Total amount of fees paid to insurance company	USD $981
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,957
Amount paid for insurance broker fees	981
Additional information about fees paid to insurance broker	OVERRIDE/NON-MONETARY COMPENSATION
Insurance broker organization code?	3

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	28
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,963
Total amount of fees paid to insurance company	USD $2,228
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,963
Amount paid for insurance broker fees	2228
Additional information about fees paid to insurance broker	OVERRIDE NON-MONETARY COMPENSATION
Insurance broker organization code?	3

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	71
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $25,953
Total amount of fees paid to insurance company	USD $5,806
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,953
Amount paid for insurance broker fees	5806
Additional information about fees paid to insurance broker	OVERRIDE NON-MONETARY COMPENSATION
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	81
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $30,668
Total amount of fees paid to insurance company	USD $6,962
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,668
Amount paid for insurance broker fees	6962
Additional information about fees paid to insurance broker	OVERRIDE NON-MONETARY COMPENSATION
Insurance broker organization code?	3

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	92
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $31,816
Total amount of fees paid to insurance company	USD $8,106
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,816
Amount paid for insurance broker fees	8106
Additional information about fees paid to insurance broker	OVERRIDE NON-MONETARY COMMISSIONS
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

1033953

Policy instance

Insurance contract or identification number	1033953
Number of Individuals Covered	50
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $22,181
Total amount of fees paid to insurance company	USD $5,714
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,181
Amount paid for insurance broker fees	5714
Additional information about fees paid to insurance broker	OVERRIDE NON-MONETARY COMMISSIONS
Insurance broker organization code?	3

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0001033953

Policy instance

Insurance contract or identification number	0001033953
Number of Individuals Covered	97
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $26,240
Total amount of fees paid to insurance company	USD $8,111
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,434
Amount paid for insurance broker fees	5506
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0001033953

Policy instance

Insurance contract or identification number	0001033953
Number of Individuals Covered	46
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $22,658
Total amount of fees paid to insurance company	USD $6,195
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,448
Amount paid for insurance broker fees	3679
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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Company Name:	COMMUNITY INTEGRATED SERVICES
Employer identification number (EIN):	232648381
NAIC Classification:	624310
NAIC Description:	Vocational Rehabilitation Services

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3378077