401k Plan data: THE CHILD CENTER 403(B) PLAN plan

THE CHILD CENTER 403(B) PLAN 401k Plan overview

Plan Name	THE CHILD CENTER 403(B) PLAN
Plan identification number	002

THE CHILD CENTER 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MENTAL HEALTH FOR CHILDREN, INC. has sponsored the creation of one or more 401k plans.

Company Name: MENTAL HEALTH FOR CHILDREN, INC.

Employer identification number (EIN): 237169042

NAIC Classification: 621340
NAIC Description: Offices of Physical, Occupational and Speech Therapists, and Audiologists

Additional information about MENTAL HEALTH FOR CHILDREN, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1971-11-15

Company Identification Number: 9500117

Legal Registered Office Address: 3995 MARCOLA RD

SPRINGFIELD
United States of America (USA)
97477

More information about MENTAL HEALTH FOR CHILDREN, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE CHILD CENTER 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 MEGHAN MELTON 2023-10-16
002 2022-01-01 MEGHAN MELTON 2024-02-14
002 2021-01-01 MEGHAN MELTON 2022-10-14
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 LUPE GARDNER
002 2016-01-01 LUPE GARDNER
002 2015-01-01 LUPE GARDNER
002 2014-01-01 LUPE GARDNER
002 2013-01-01 LUPE GARDNER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2022-01-01	MEGHAN MELTON	2023-10-16
002	2022-01-01	MEGHAN MELTON	2024-02-14
002	2021-01-01	MEGHAN MELTON	2022-10-14
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	LUPE GARDNER
002	2016-01-01	LUPE GARDNER
002	2015-01-01	LUPE GARDNER
002	2014-01-01	LUPE GARDNER
002	2013-01-01	LUPE GARDNER

Plan Statistics for THE CHILD CENTER 403(B) PLAN

401k plan membership statisitcs for THE CHILD CENTER 403(B) PLAN

Measure Date Value
2022: THE CHILD CENTER 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 288
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 82
Number of retired or separated participants receiving benefits 2022-01-01 96
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 178
Number of participants with account balances 2022-01-01 161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: THE CHILD CENTER 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 290
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 106
Number of retired or separated participants receiving benefits 2021-01-01 11
Number of other retired or separated participants entitled to future benefits 2021-01-01 171
Total of all active and inactive participants 2021-01-01 288
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 288
Number of participants with account balances 2021-01-01 258
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: THE CHILD CENTER 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 294
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 118
Number of retired or separated participants receiving benefits 2020-01-01 14
Number of other retired or separated participants entitled to future benefits 2020-01-01 158
Total of all active and inactive participants 2020-01-01 290
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 290
Number of participants with account balances 2020-01-01 261
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: THE CHILD CENTER 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 275
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 133
Number of retired or separated participants receiving benefits 2019-01-01 14
Number of other retired or separated participants entitled to future benefits 2019-01-01 144
Total of all active and inactive participants 2019-01-01 291
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 291
Number of participants with account balances 2019-01-01 247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: THE CHILD CENTER 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 120
Number of retired or separated participants receiving benefits 2018-01-01 10
Number of other retired or separated participants entitled to future benefits 2018-01-01 142
Total of all active and inactive participants 2018-01-01 272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 272
Number of participants with account balances 2018-01-01 233
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: THE CHILD CENTER 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 238
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 100
Number of retired or separated participants receiving benefits 2017-01-01 9
Number of other retired or separated participants entitled to future benefits 2017-01-01 138
Total of all active and inactive participants 2017-01-01 247
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 247
Number of participants with account balances 2017-01-01 228
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1
2016: THE CHILD CENTER 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 89
Number of retired or separated participants receiving benefits 2016-01-01 9
Number of other retired or separated participants entitled to future benefits 2016-01-01 140
Total of all active and inactive participants 2016-01-01 238
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 238
Number of participants with account balances 2016-01-01 207
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: THE CHILD CENTER 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 67
Number of retired or separated participants receiving benefits 2015-01-01 5
Number of other retired or separated participants entitled to future benefits 2015-01-01 133
Total of all active and inactive participants 2015-01-01 205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 205
Number of participants with account balances 2015-01-01 202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: THE CHILD CENTER 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 66
Number of retired or separated participants receiving benefits 2014-01-01 6
Number of other retired or separated participants entitled to future benefits 2014-01-01 128
Total of all active and inactive participants 2014-01-01 200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 200
Number of participants with account balances 2014-01-01 194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: THE CHILD CENTER 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 184
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 70
Number of retired or separated participants receiving benefits 2013-01-01 6
Number of other retired or separated participants entitled to future benefits 2013-01-01 120
Total of all active and inactive participants 2013-01-01 196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 196
Number of participants with account balances 2013-01-01 189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2022: THE CHILD CENTER 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	288
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	82
Number of retired or separated participants receiving benefits	2022-01-01	96
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	178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	178
Number of participants with account balances	2022-01-01	161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: THE CHILD CENTER 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	290
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	106
Number of retired or separated participants receiving benefits	2021-01-01	11
Number of other retired or separated participants entitled to future benefits	2021-01-01	171
Total of all active and inactive participants	2021-01-01	288
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	288
Number of participants with account balances	2021-01-01	258
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: THE CHILD CENTER 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	294
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	118
Number of retired or separated participants receiving benefits	2020-01-01	14
Number of other retired or separated participants entitled to future benefits	2020-01-01	158
Total of all active and inactive participants	2020-01-01	290
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	290
Number of participants with account balances	2020-01-01	261
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: THE CHILD CENTER 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	133
Number of retired or separated participants receiving benefits	2019-01-01	14
Number of other retired or separated participants entitled to future benefits	2019-01-01	144
Total of all active and inactive participants	2019-01-01	291
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	291
Number of participants with account balances	2019-01-01	247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: THE CHILD CENTER 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	120
Number of retired or separated participants receiving benefits	2018-01-01	10
Number of other retired or separated participants entitled to future benefits	2018-01-01	142
Total of all active and inactive participants	2018-01-01	272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	272
Number of participants with account balances	2018-01-01	233
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: THE CHILD CENTER 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	238
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	100
Number of retired or separated participants receiving benefits	2017-01-01	9
Number of other retired or separated participants entitled to future benefits	2017-01-01	138
Total of all active and inactive participants	2017-01-01	247
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	247
Number of participants with account balances	2017-01-01	228
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: THE CHILD CENTER 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	89
Number of retired or separated participants receiving benefits	2016-01-01	9
Number of other retired or separated participants entitled to future benefits	2016-01-01	140
Total of all active and inactive participants	2016-01-01	238
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	238
Number of participants with account balances	2016-01-01	207
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: THE CHILD CENTER 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	67
Number of retired or separated participants receiving benefits	2015-01-01	5
Number of other retired or separated participants entitled to future benefits	2015-01-01	133
Total of all active and inactive participants	2015-01-01	205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	205
Number of participants with account balances	2015-01-01	202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: THE CHILD CENTER 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	66
Number of retired or separated participants receiving benefits	2014-01-01	6
Number of other retired or separated participants entitled to future benefits	2014-01-01	128
Total of all active and inactive participants	2014-01-01	200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	200
Number of participants with account balances	2014-01-01	194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: THE CHILD CENTER 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	184
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	70
Number of retired or separated participants receiving benefits	2013-01-01	6
Number of other retired or separated participants entitled to future benefits	2013-01-01	120
Total of all active and inactive participants	2013-01-01	196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	196
Number of participants with account balances	2013-01-01	189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on THE CHILD CENTER 403(B) PLAN

Measure	Date	Value
2022 : THE CHILD CENTER 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-261,739
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$925,670
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$925,478
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$455,929
Value of total assets at end of year	2022-12-31	$3,940,408
Value of total assets at beginning of year	2022-12-31	$5,127,817
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$192
Total interest from all sources	2022-12-31	$3,154
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$400,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$149,191
Participant contributions at end of year	2022-12-31	$57,876
Participant contributions at beginning of year	2022-12-31	$84,319
Participant contributions at end of year	2022-12-31	$12,763
Participant contributions at beginning of year	2022-12-31	$19,791
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$43,040
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$2,367
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$2,873
Administrative expenses (other) incurred	2022-12-31	$192
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-1,187,409
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,940,408
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,127,817
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$312,682
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$718,672
Interest on participant loans	2022-12-31	$3,154
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$3,533,725
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$4,261,026
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-720,822
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$263,698
Employer contributions (assets) at end of year	2022-12-31	$20,995
Employer contributions (assets) at beginning of year	2022-12-31	$41,136
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$925,478
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Disclaimer
Accountancy firm name	2022-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2022-12-31	930396435
2021 : THE CHILD CENTER 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,040,880
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$194,748
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$194,411
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$468,480
Value of total assets at end of year	2021-12-31	$5,127,817
Value of total assets at beginning of year	2021-12-31	$4,281,685
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$337
Total interest from all sources	2021-12-31	$2,415
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$400,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$130,323
Participant contributions at end of year	2021-12-31	$84,319
Participant contributions at beginning of year	2021-12-31	$31,432
Participant contributions at end of year	2021-12-31	$19,791
Participant contributions at beginning of year	2021-12-31	$8,098
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$72,566
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$2,873
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$0
Administrative expenses (other) incurred	2021-12-31	$337
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$846,132
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,127,817
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,281,685
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$718,672
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$729,649
Interest on participant loans	2021-12-31	$2,415
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$4,261,026
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$3,491,723
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$569,985
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$265,591
Employer contributions (assets) at end of year	2021-12-31	$41,136
Employer contributions (assets) at beginning of year	2021-12-31	$20,783
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$194,411
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2021-12-31	930396435
2020 : THE CHILD CENTER 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$811,009
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$292,189
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$291,985
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$378,796
Value of total assets at end of year	2020-12-31	$4,281,685
Value of total assets at beginning of year	2020-12-31	$3,762,865
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$204
Total interest from all sources	2020-12-31	$1,646
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$400,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$116,695
Participant contributions at end of year	2020-12-31	$31,432
Participant contributions at beginning of year	2020-12-31	$71,403
Participant contributions at end of year	2020-12-31	$8,098
Participant contributions at beginning of year	2020-12-31	$10,573
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$26,704
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$1,323
Administrative expenses (other) incurred	2020-12-31	$204
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$518,820
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,281,685
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,762,865
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$729,649
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$730,882
Interest on participant loans	2020-12-31	$1,646
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$3,491,723
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$2,930,252
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$430,567
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$235,397
Employer contributions (assets) at end of year	2020-12-31	$20,783
Employer contributions (assets) at beginning of year	2020-12-31	$18,432
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$291,985
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2020-12-31	930396435
2019 : THE CHILD CENTER 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$867,007
Total income from all sources (including contributions)	2019-12-31	$867,007
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$312,090
Total of all expenses incurred	2019-12-31	$312,090
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$312,090
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$312,090
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$337,624
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$337,624
Value of total assets at end of year	2019-12-31	$3,762,865
Value of total assets at end of year	2019-12-31	$3,762,865
Value of total assets at beginning of year	2019-12-31	$3,207,948
Value of total assets at beginning of year	2019-12-31	$3,207,948
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$0
Total interest from all sources	2019-12-31	$2,461
Total interest from all sources	2019-12-31	$2,461
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$400,000
Value of fidelity bond cover	2019-12-31	$400,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$117,473
Contributions received from participants	2019-12-31	$117,473
Participant contributions at end of year	2019-12-31	$71,403
Participant contributions at end of year	2019-12-31	$71,403
Participant contributions at beginning of year	2019-12-31	$58,234
Participant contributions at end of year	2019-12-31	$10,573
Participant contributions at beginning of year	2019-12-31	$9,037
Participant contributions at beginning of year	2019-12-31	$9,037
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$6,321
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$6,321
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$1,323
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$1,323
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$1,562
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$1,562
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$554,917
Value of net income/loss	2019-12-31	$554,917
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,762,865
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,762,865
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,207,948
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,207,948
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$730,882
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$730,882
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$789,340
Interest on participant loans	2019-12-31	$2,461
Interest on participant loans	2019-12-31	$2,461
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$2,930,252
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$2,930,252
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$2,334,054
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$2,334,054
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$526,922
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$526,922
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$213,830
Contributions received in cash from employer	2019-12-31	$213,830
Employer contributions (assets) at end of year	2019-12-31	$18,432
Employer contributions (assets) at beginning of year	2019-12-31	$15,721
Employer contributions (assets) at beginning of year	2019-12-31	$15,721
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$312,090
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$312,090
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	KERNUTT STOKES LLP
Accountancy firm name	2019-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2019-12-31	930396435
Accountancy firm EIN	2019-12-31	930396435
2018 : THE CHILD CENTER 403(B) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$190,089
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$167,673
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$307,279
Value of total assets at end of year	2018-12-31	$3,207,948
Value of total assets at beginning of year	2018-12-31	$3,185,532
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$167,673
Total interest from all sources	2018-12-31	$2,069
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$167,673
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$300,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$113,174
Participant contributions at end of year	2018-12-31	$58,234
Participant contributions at beginning of year	2018-12-31	$43,732
Participant contributions at end of year	2018-12-31	$9,037
Participant contributions at beginning of year	2018-12-31	$10,037
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$1,562
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$22,416
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,207,948
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,185,532
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$789,340
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$787,457
Interest on participant loans	2018-12-31	$2,069
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$2,334,054
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$2,328,162
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-119,259
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$194,105
Employer contributions (assets) at end of year	2018-12-31	$15,721
Employer contributions (assets) at beginning of year	2018-12-31	$16,144
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2018-12-31	930396435
2017 : THE CHILD CENTER 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$621,584
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$153,800
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$153,800
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$305,158
Value of total assets at end of year	2017-12-31	$3,185,532
Value of total assets at beginning of year	2017-12-31	$2,717,748
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$0
Total interest from all sources	2017-12-31	$1,244
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$300,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$106,752
Participant contributions at end of year	2017-12-31	$43,732
Participant contributions at beginning of year	2017-12-31	$49,836
Participant contributions at end of year	2017-12-31	$10,037
Participant contributions at beginning of year	2017-12-31	$6,329
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$21,186
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$467,784
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,185,532
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,717,748
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$787,457
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$860,145
Interest on participant loans	2017-12-31	$1,244
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$2,328,162
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,787,994
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$315,182
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$177,220
Employer contributions (assets) at end of year	2017-12-31	$16,144
Employer contributions (assets) at beginning of year	2017-12-31	$13,444
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$153,800
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2017-12-31	930396435
2016 : THE CHILD CENTER 403(B) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$340,298
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$182,782
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$182,782
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$218,137
Value of total assets at end of year	2016-12-31	$2,717,748
Value of total assets at beginning of year	2016-12-31	$2,560,232
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$1,582
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$300,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$55,756
Participant contributions at end of year	2016-12-31	$49,836
Participant contributions at beginning of year	2016-12-31	$53,497
Participant contributions at end of year	2016-12-31	$6,329
Participant contributions at beginning of year	2016-12-31	$4,163
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$157,516
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,717,748
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,560,232
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$860,145
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,284,943
Interest on participant loans	2016-12-31	$1,582
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,787,994
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,204,569
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$120,579
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$162,381
Employer contributions (assets) at end of year	2016-12-31	$13,444
Employer contributions (assets) at beginning of year	2016-12-31	$13,060
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$182,782
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2016-12-31	930396435
2015 : THE CHILD CENTER 403(B) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$231,428
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$198,147
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$197,797
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$205,221
Value of total assets at end of year	2015-12-31	$2,560,232
Value of total assets at beginning of year	2015-12-31	$2,526,951
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$350
Total interest from all sources	2015-12-31	$2,990
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$350
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$300,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$53,001
Participant contributions at end of year	2015-12-31	$53,497
Participant contributions at beginning of year	2015-12-31	$36,927
Participant contributions at end of year	2015-12-31	$4,163
Participant contributions at beginning of year	2015-12-31	$3,995
Other income not declared elsewhere	2015-12-31	$34,522
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$33,281
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,560,232
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,526,951
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,284,943
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,183,718
Interest on participant loans	2015-12-31	$2,990
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$1,204,569
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,290,405
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-11,305
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$152,220
Employer contributions (assets) at end of year	2015-12-31	$13,060
Employer contributions (assets) at beginning of year	2015-12-31	$11,906
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$197,797
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2015-12-31	930396435
2014 : THE CHILD CENTER 403(B) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$318,518
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$509,495
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$509,147
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$201,248
Value of total assets at end of year	2014-12-31	$2,526,951
Value of total assets at beginning of year	2014-12-31	$2,717,928
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$348
Total interest from all sources	2014-12-31	$458
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$348
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$166,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$57,586
Participant contributions at end of year	2014-12-31	$36,927
Participant contributions at beginning of year	2014-12-31	$54,161
Participant contributions at end of year	2014-12-31	$3,995
Participant contributions at beginning of year	2014-12-31	$5,900
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-190,977
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,526,951
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,717,928
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$1,183,718
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,165,751
Interest on participant loans	2014-12-31	$458
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,290,405
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,479,729
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$116,812
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$143,662
Employer contributions (assets) at end of year	2014-12-31	$11,906
Employer contributions (assets) at beginning of year	2014-12-31	$12,387
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$509,147
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2014-12-31	930396435
2013 : THE CHILD CENTER 403(B) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$498,590
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$177,459
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$177,111
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$201,548
Value of total assets at end of year	2013-12-31	$2,717,928
Value of total assets at beginning of year	2013-12-31	$2,396,797
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$348
Total interest from all sources	2013-12-31	$3,030
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$348
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$166,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$58,071
Participant contributions at end of year	2013-12-31	$54,161
Participant contributions at beginning of year	2013-12-31	$54,233
Participant contributions at end of year	2013-12-31	$5,900
Participant contributions at beginning of year	2013-12-31	$4,693
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$321,131
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,717,928
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,396,797
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,165,751
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,196,970
Income. Interest from loans (other than to participants)	2013-12-31	$3,030
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$1,479,729
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$1,125,574
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$294,012
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$143,477
Employer contributions (assets) at end of year	2013-12-31	$12,387
Employer contributions (assets) at beginning of year	2013-12-31	$15,327
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$177,111
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	KERNUTT STOKES LLP
Accountancy firm EIN	2013-12-31	930396435

Form 5500 Responses for THE CHILD CENTER 403(B) PLAN

2022: THE CHILD CENTER 403(B) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: THE CHILD CENTER 403(B) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: THE CHILD CENTER 403(B) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: THE CHILD CENTER 403(B) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: THE CHILD CENTER 403(B) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: THE CHILD CENTER 403(B) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: THE CHILD CENTER 403(B) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: THE CHILD CENTER 403(B) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: THE CHILD CENTER 403(B) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: THE CHILD CENTER 403(B) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

0000CHIL00OR00R

Policy instance

Insurance contract or identification number	0000CHIL00OR00R
Number of Individuals Covered	17
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $898
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $898
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	18
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $197
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $197
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	3
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
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

0000CHIL00OR00R

Policy instance

Insurance contract or identification number	0000CHIL00OR00R
Number of Individuals Covered	18
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $984
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $984
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	121
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $367
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $367
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	10
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	10
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	130
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $345
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $332
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

0000CHIL00OR00R

Policy instance

Insurance contract or identification number	0000CHIL00OR00R
Number of Individuals Covered	18
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,424
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,424
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

0000CHIL00OR00R

Policy instance

Insurance contract or identification number	0000CHIL00OR00R
Number of Individuals Covered	18
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,424
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,424
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	130
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $345
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $332
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	10
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	11
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $24
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	136
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $322
Total amount of fees paid to insurance company	USD $144
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $317
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

0000CHIL00OR00R

Policy instance

Insurance contract or identification number	0000CHIL00OR00R
Number of Individuals Covered	19
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,789
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,789
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

Policy instance

Insurance contract or identification number	NA
Number of Individuals Covered	21
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,384
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,384
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3
Insurance broker name	WADDELL & REED, INC.

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	151
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $320
Total amount of fees paid to insurance company	USD $327
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $296
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3
Insurance broker name	KOWALSKI, LEO JOHN III

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	13
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $30
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3
Insurance broker name	DOLECHEK, ROBERT JOSEPH

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

Policy instance

Insurance contract or identification number	NA
Number of Individuals Covered	50
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	LEGEND EQUITIES CORPORATION

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	100
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $91
Total amount of fees paid to insurance company	USD $6
Are there contracts with allocated funds for individual policies?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45
Insurance broker organization code?	3
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	SERVICE
Insurance broker name	KOWALSKI, LEO J IV JUNIOR

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	100
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,135
Total amount of fees paid to insurance company	USD $1,774
Are there contracts with allocated funds for individual policies?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $397
Amount paid for insurance broker fees	1023
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3
Insurance broker name	CASCADE PACIFIC INS SVC

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	170
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,009
Total amount of fees paid to insurance company	USD $6
Are there contracts with allocated funds for individual policies?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,042
Insurance broker organization code?	3
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	SERVICES
Insurance broker name	WARD, NED C

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	170
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $221
Total amount of fees paid to insurance company	USD $1
Are there contracts with allocated funds for individual policies?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $129
Insurance broker organization code?	3
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	SERVICES
Insurance broker name	KOWALSKI, LEO J IV JUNIOR

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

Policy instance

Insurance contract or identification number	NA
Number of Individuals Covered	28
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,665
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,665
Insurance broker organization code?	3
Insurance broker name	LEGEND EQUITIES CORPORATION

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

Policy contract number

0000T0947A

Policy instance

Insurance contract or identification number	0000T0947A
Number of Individuals Covered	190
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,077
Total amount of fees paid to insurance company	USD $771
Are there contracts with allocated funds for individual policies?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,511
Amount paid for insurance broker fees	446
Additional information about fees paid to insurance broker	SERVICES
Insurance broker organization code?	3
Insurance broker name	LEO JOHN KOWALSKI III

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

Policy contract number

0000T09470

Policy instance

Insurance contract or identification number	0000T09470
Number of Individuals Covered	190
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $148
Total amount of fees paid to insurance company	USD $49
Are there contracts with allocated funds for individual policies?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $118
Amount paid for insurance broker fees	29
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3
Insurance broker name	THE ANNUITY SOURCE INC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

Policy instance

Insurance contract or identification number	NA
Number of Individuals Covered	190
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,704
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,704
Insurance broker organization code?	3
Insurance broker name	LEGEND EQUITIES CORPORATION

Potentially related plans

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Company Name:	MENTAL HEALTH FOR CHILDREN, INC.
Employer identification number (EIN):	237169042
NAIC Classification:	621340
NAIC Description:	Offices of Physical, Occupational and Speech Therapists, and Audiologists

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1971-11-15
Company Identification Number:	9500117
Legal Registered Office Address:	3995 MARCOLA RD SPRINGFIELD United States of America (USA) 97477