401k Plan data: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN plan

PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 401k Plan overview

Plan Name	PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN
Plan identification number	501

PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

PINNACLE VENTURE INVESTMENTS, LLC has sponsored the creation of one or more 401k plans.

Company Name: PINNACLE VENTURE INVESTMENTS, LLC

Employer identification number (EIN): 273708189

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 JEFFREY C. FREEMAN
501 2011-01-01 JEFFREY C. FREEMAN

Plan Statistics for PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN

401k plan membership statisitcs for PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN

Measure Date Value
2015: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 105
Total of all active and inactive participants 2015-01-01 105
2014: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 94
Total of all active and inactive participants 2014-01-01 94
2013: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 115
Total of all active and inactive participants 2013-01-01 115
2012: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 126
Total of all active and inactive participants 2012-01-01 126
2011: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 132
Total of all active and inactive participants 2011-01-01 132

Measure	Date	Value
2015: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	105
Total of all active and inactive participants	2015-01-01	105
2014: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	94
Total of all active and inactive participants	2014-01-01	94
2013: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	115
Total of all active and inactive participants	2013-01-01	115
2012: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	126
Total of all active and inactive participants	2012-01-01	126
2011: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	132
Total of all active and inactive participants	2011-01-01	132

Form 5500 Responses for PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN

2015: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: PINNACLE VENTURE INVESTMENTS, LLC GROUP HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

32719000

Policy instance

Insurance contract or identification number	32719000
Number of Individuals Covered	150
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $16,802
Total amount of fees paid to insurance company	USD $12,197
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CONTINGENT PREMIUM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,349
Amount paid for insurance broker fees	11396
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES
Insurance broker organization code?	3
Insurance broker name	CREATIVE PLANNING BENEFITS, LLC

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52420-000-00002

Policy instance

Insurance contract or identification number	52420-000-00002
Number of Individuals Covered	4
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA
Welfare Benefit Premiums Paid to Carrier	USD $1,317
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
Insurance broker organization code?	3
Insurance broker name	CREATIVE PLANNING BENEFITS, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5461157

Policy instance

Insurance contract or identification number	5461157
Number of Individuals Covered	105
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,820
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $31,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,801
Insurance broker organization code?	3
Insurance broker name	POWER GROUP COMPANY, LLC

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52420-000-00001

Policy instance

Insurance contract or identification number	52420-000-00001
Number of Individuals Covered	81
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,460
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,460
Insurance broker organization code?	3
Insurance broker name	CREATIVE PLANNING BENEFITS, LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5461157

Policy instance

Insurance contract or identification number	5461157
Number of Individuals Covered	94
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,175
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $29,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,175
Insurance broker organization code?	3
Insurance broker name	CRETCHER HEARTLAND LLC

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52420-000-00001

Policy instance

Insurance contract or identification number	52420-000-00001
Number of Individuals Covered	78
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,138
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,138
Insurance broker organization code?	3
Insurance broker name	CRETCHER HEARTLAND LLC

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

32719000

Policy instance

Insurance contract or identification number	32719000
Number of Individuals Covered	129
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,339
Total amount of fees paid to insurance company	USD $12,341
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CONTINGENT PREMIUM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,339
Amount paid for insurance broker fees	12341
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES
Insurance broker organization code?	3
Insurance broker name	CRETCHER HEARTLAND LLC

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52420-000-00002

Policy instance

Insurance contract or identification number	52420-000-00002
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA
Welfare Benefit Premiums Paid to Carrier	USD $1,332
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
Insurance broker name	CRETCHER HEARTLAND LLC

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

8120-1099

Policy instance

Insurance contract or identification number	8120-1099
Number of Individuals Covered	89
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,506
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,506
Insurance broker organization code?	3
Insurance broker name	CRETCHER HEARTLAND LLC

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

32719000

Policy instance

Insurance contract or identification number	32719000
Number of Individuals Covered	156
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $15,675
Total amount of fees paid to insurance company	USD $12,173
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CONTINGENT PREMIUM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,675
Amount paid for insurance broker fees	12173
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES TO BCBS
Insurance broker organization code?	3
Insurance broker name	CRETCHER HEARTLAND LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5461157

Policy instance

Insurance contract or identification number	5461157
Number of Individuals Covered	115
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,917
Total amount of fees paid to insurance company	USD $319
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $30,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,917
Amount paid for insurance broker fees	319
Insurance broker organization code?	3
Insurance broker name	CRETCHER HEARTLAND LLC

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

32719000

Policy instance

Insurance contract or identification number	32719000
Number of Individuals Covered	177
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $18,465
Total amount of fees paid to insurance company	USD $15,480
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	MAXIMUM REFUND
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,465
Amount paid for insurance broker fees	15480
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES TO BCBSKC
Insurance broker organization code?	3
Insurance broker name	CRETCHER HEARTLAND LLC

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5461157

Policy instance

Insurance contract or identification number	5461157
Number of Individuals Covered	126
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,729
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $36,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,729
Insurance broker organization code?	3
Insurance broker name	CRETCHER HEARTLAND LLC

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

8120-1099

Policy instance

Insurance contract or identification number	8120-1099
Number of Individuals Covered	190
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,812
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,604
Insurance broker organization code?	3
Insurance broker name	CREATIVE PLANNING BENEFITS, LLC

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

32719000

Policy instance

Insurance contract or identification number	32719000
Number of Individuals Covered	234
Insurance policy start date	2011-09-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,622
Total amount of fees paid to insurance company	USD $7,705
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	FULLY INSURED
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )

Policy contract number

8120-1099

Policy instance

Insurance contract or identification number	8120-1099
Number of Individuals Covered	252
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,585
Total amount of fees paid to insurance company	USD $467
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00444507

Policy instance

Insurance contract or identification number	00444507
Number of Individuals Covered	163
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,580
Total amount of fees paid to insurance company	USD $1,164
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $30,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

32719000

Policy instance

Insurance contract or identification number	32719000
Number of Individuals Covered	229
Insurance policy start date	2011-01-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $15,288
Total amount of fees paid to insurance company	USD $15,340
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	FULLY INSURED
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

PINNACLE VENTURES 401(K) PLAN [EIN = 943402282]

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Company Name:	PINNACLE VENTURE INVESTMENTS, LLC
Employer identification number (EIN):	273708189
NAIC Classification:	611000