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CAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameCAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN
Plan identification number 501

CAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CAPITOL HOME HEALTH has sponsored the creation of one or more 401k plans.

Company Name:CAPITOL HOME HEALTH
Employer identification number (EIN):272266477
NAIC Classification:621610
NAIC Description:Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-10-01GILLIAN JACOB2021-04-13

Plan Statistics for CAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN

401k plan membership statisitcs for CAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN

Measure Date Value
2019: CAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01119
Total number of active participants reported on line 7a of the Form 55002019-10-0192
Number of retired or separated participants receiving benefits2019-10-015
Number of other retired or separated participants entitled to future benefits2019-10-0144
Total of all active and inactive participants2019-10-01141
Number of employers contributing to the scheme2019-10-010

Form 5500 Responses for CAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN

2019: CAPITOL HOME HEALTH - HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01First time form 5500 has been submittedYes
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number829714
Policy instance 1
Insurance contract or identification number829714
Number of Individuals Covered60
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $4,779
Total amount of fees paid to insurance companyUSD $2,266
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,779
Amount paid for insurance broker fees2266
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 95161 )
Policy contract number829714
Policy instance 2
Insurance contract or identification number829714
Number of Individuals Covered13
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $481
Total amount of fees paid to insurance companyUSD $675
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $481
Amount paid for insurance broker fees675
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number829714
Policy instance 3
Insurance contract or identification number829714
Number of Individuals Covered67
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $35,311
Total amount of fees paid to insurance companyUSD $2,379
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $800,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,311
Amount paid for insurance broker fees2379
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BLGB
Policy instance 4
Insurance contract or identification numberGLUG0BLGB
Number of Individuals Covered82
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $6,143
Total amount of fees paid to insurance companyUSD $1,201
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $61,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,143
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION

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