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SHAWNEE MENTAL HEALTH CTR, INC 401k Plan overview

Plan NameSHAWNEE MENTAL HEALTH CTR, INC
Plan identification number 003

SHAWNEE MENTAL HEALTH CTR, INC Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock 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

SHAWNEE MENTAL HEALTH CENTER INC. has sponsored the creation of one or more 401k plans.

Company Name:SHAWNEE MENTAL HEALTH CENTER INC.
Employer identification number (EIN):310843758
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHAWNEE MENTAL HEALTH CTR, INC

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032022-01-01
0032021-01-01
0032020-01-01
0032020-01-01
0032020-01-01
0032019-01-01
0032019-01-01
0032018-01-01
0032017-01-01JILL COTTRILL JILL COTTRILL2018-10-10
0032016-01-01JILL COTTRILL JILL COTTRILL2017-10-13
0032015-01-01JILL COTTRILL JILL COTTRILL2016-10-13
0032014-01-01JILL COTTRILL
0032013-01-01JILL COTTRILL
0032012-01-01JILL COTTRILL
0032011-01-01JILL COTTRILL
0032010-01-01GWYN LEWIS

Plan Statistics for SHAWNEE MENTAL HEALTH CTR, INC

401k plan membership statisitcs for SHAWNEE MENTAL HEALTH CTR, INC

Measure Date Value
2022: SHAWNEE MENTAL HEALTH CTR, INC 2022 401k membership
Total participants, beginning-of-year2022-01-01141
Total number of active participants reported on line 7a of the Form 55002022-01-01143
Number of retired or separated participants receiving benefits2022-01-016
Number of other retired or separated participants entitled to future benefits2022-01-0126
Total of all active and inactive participants2022-01-01175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01175
Number of participants with account balances2022-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0115
2021: SHAWNEE MENTAL HEALTH CTR, INC 2021 401k membership
Total participants, beginning-of-year2021-01-01133
Total number of active participants reported on line 7a of the Form 55002021-01-01138
Number of retired or separated participants receiving benefits2021-01-013
Number of other retired or separated participants entitled to future benefits2021-01-0123
Total of all active and inactive participants2021-01-01164
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01164
Number of participants with account balances2021-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-011
2020: SHAWNEE MENTAL HEALTH CTR, INC 2020 401k membership
Total participants, beginning-of-year2020-01-01139
Total number of active participants reported on line 7a of the Form 55002020-01-01125
Number of retired or separated participants receiving benefits2020-01-013
Number of other retired or separated participants entitled to future benefits2020-01-0125
Total of all active and inactive participants2020-01-01153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01153
Number of participants with account balances2020-01-0194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-011
2019: SHAWNEE MENTAL HEALTH CTR, INC 2019 401k membership
Total participants, beginning-of-year2019-01-01135
Total number of active participants reported on line 7a of the Form 55002019-01-01132
Number of retired or separated participants receiving benefits2019-01-013
Number of other retired or separated participants entitled to future benefits2019-01-0127
Total of all active and inactive participants2019-01-01162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01162
Number of participants with account balances2019-01-0194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-011
2018: SHAWNEE MENTAL HEALTH CTR, INC 2018 401k membership
Total participants, beginning-of-year2018-01-01154
Total number of active participants reported on line 7a of the Form 55002018-01-01123
Number of retired or separated participants receiving benefits2018-01-014
Number of other retired or separated participants entitled to future benefits2018-01-0127
Total of all active and inactive participants2018-01-01154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01154
Number of participants with account balances2018-01-0187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-011
2017: SHAWNEE MENTAL HEALTH CTR, INC 2017 401k membership
Total participants, beginning-of-year2017-01-01143
Total number of active participants reported on line 7a of the Form 55002017-01-01123
Number of retired or separated participants receiving benefits2017-01-013
Number of other retired or separated participants entitled to future benefits2017-01-0125
Total of all active and inactive participants2017-01-01151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01151
Number of participants with account balances2017-01-0187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-011
2016: SHAWNEE MENTAL HEALTH CTR, INC 2016 401k membership
Total participants, beginning-of-year2016-01-0183
Total number of active participants reported on line 7a of the Form 55002016-01-0155
Number of retired or separated participants receiving benefits2016-01-013
Number of other retired or separated participants entitled to future benefits2016-01-0125
Total of all active and inactive participants2016-01-0183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0183
Number of participants with account balances2016-01-0182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-012
2015: SHAWNEE MENTAL HEALTH CTR, INC 2015 401k membership
Total participants, beginning-of-year2015-01-0181
Total number of active participants reported on line 7a of the Form 55002015-01-0157
Number of retired or separated participants receiving benefits2015-01-012
Number of other retired or separated participants entitled to future benefits2015-01-0124
Total of all active and inactive participants2015-01-0183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0183
Number of participants with account balances2015-01-0182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-014
2014: SHAWNEE MENTAL HEALTH CTR, INC 2014 401k membership
Total participants, beginning-of-year2014-01-01150
Total number of active participants reported on line 7a of the Form 55002014-01-0158
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0123
Total of all active and inactive participants2014-01-0181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0181
Number of participants with account balances2014-01-0181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012
2013: SHAWNEE MENTAL HEALTH CTR, INC 2013 401k membership
Total participants, beginning-of-year2013-01-0179
Total number of active participants reported on line 7a of the Form 55002013-01-0159
Number of retired or separated participants receiving benefits2013-01-0119
Total of all active and inactive participants2013-01-0178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0178
Number of participants with account balances2013-01-0178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-016
2012: SHAWNEE MENTAL HEALTH CTR, INC 2012 401k membership
Total participants, beginning-of-year2012-01-01137
Total number of active participants reported on line 7a of the Form 55002012-01-01126
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0116
Total of all active and inactive participants2012-01-01142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01142
Number of participants with account balances2012-01-0178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-014
2011: SHAWNEE MENTAL HEALTH CTR, INC 2011 401k membership
Total participants, beginning-of-year2011-01-01129
Total number of active participants reported on line 7a of the Form 55002011-01-0167
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-019
Total of all active and inactive participants2011-01-0176
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0176
Number of participants with account balances2011-01-0175
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-011
2010: SHAWNEE MENTAL HEALTH CTR, INC 2010 401k membership
Total participants, beginning-of-year2010-01-01143
Total number of active participants reported on line 7a of the Form 55002010-01-01121
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-018
Total of all active and inactive participants2010-01-01129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01129
Number of participants with account balances2010-01-0172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-011

Financial Data on SHAWNEE MENTAL HEALTH CTR, INC

Measure Date Value
2022 : SHAWNEE MENTAL HEALTH CTR, INC 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets2022-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$0
Total unrealized appreciation/depreciation of assets2022-12-31$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
Expenses. Interest paid2022-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022022-12-31$0
Total income from all sources (including contributions)2022-12-31$-451,928
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$650,395
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$648,109
Expenses. Certain deemed distributions of participant loans2022-12-31$1,580
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$470,394
Value of total assets at end of year2022-12-31$4,950,908
Value of total assets at beginning of year2022-12-31$6,053,231
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$706
Total income from rents2022-12-31$0
Total interest from all sources2022-12-31$28,296
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$209,990
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$209,990
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Administrative expenses professional fees incurred2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$268,705
Participant contributions at end of year2022-12-31$7,836
Participant contributions at beginning of year2022-12-31$31,205
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$17,374
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-1,102,323
Value of net assets at end of year (total assets less liabilities)2022-12-31$4,950,908
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$6,053,231
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Investment advisory and management fees2022-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$3,909,839
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$5,136,539
Interest on participant loans2022-12-31$719
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$27,577
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$1,033,233
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$885,487
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,160,608
Net investment gain/loss from pooled separate accounts2022-12-31$0
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Assets. Invements in employer securities at end of year2022-12-31$0
Assets. Invements in employer securities at beginning of year2022-12-31$0
Assets. Value of employer real property at end of year2022-12-31$0
Assets. Value of employer real property at beginning of year2022-12-31$0
Contributions received in cash from employer2022-12-31$184,315
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$648,109
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Contract administrator fees2022-12-31$706
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$0
Aggregate carrying amount (costs) on sale of assets2022-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31HESS, STEWART, & CAMPBELL, PLLC
Accountancy firm EIN2022-12-31550657218
2021 : SHAWNEE MENTAL HEALTH CTR, INC 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$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$1,019,235
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$672,421
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$671,849
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$442,707
Value of total assets at end of year2021-12-31$6,053,231
Value of total assets at beginning of year2021-12-31$5,706,417
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$572
Total interest from all sources2021-12-31$29,245
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 year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$258,071
Participant contributions at end of year2021-12-31$31,205
Participant contributions at beginning of year2021-12-31$42,881
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$2,365
Administrative expenses (other) incurred2021-12-31$572
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$346,814
Value of net assets at end of year (total assets less liabilities)2021-12-31$6,053,231
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$5,706,417
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$5,136,539
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$4,809,778
Interest on participant loans2021-12-31$2,166
Interest earned on other investments2021-12-31$27,079
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$885,487
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$853,758
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$547,283
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$182,271
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$671,849
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31HESS, STEWART & CAMPBELL, PLLC
Accountancy firm EIN2021-12-31550657218
2020 : SHAWNEE MENTAL HEALTH CTR, INC 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$-49
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$1,146,950
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$284,842
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$282,633
Value of total corrective distributions2020-12-31$1,650
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$403,298
Value of total assets at end of year2020-12-31$5,706,417
Value of total assets at beginning of year2020-12-31$4,844,358
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$559
Total interest from all sources2020-12-31$27,971
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 year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$239,222
Participant contributions at end of year2020-12-31$42,881
Participant contributions at beginning of year2020-12-31$51,815
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$2,425
Administrative expenses (other) incurred2020-12-31$559
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$862,108
Value of net assets at end of year (total assets less liabilities)2020-12-31$5,706,417
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$4,844,358
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$4,809,778
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$3,893,148
Interest on participant loans2020-12-31$2,823
Interest earned on other investments2020-12-31$25,148
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$853,758
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$899,395
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$715,681
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$161,651
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$282,633
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31HESS , STEWART & CAMPBELL, PLLC
Accountancy firm EIN2020-12-31550657218
2019 : SHAWNEE MENTAL HEALTH CTR, INC 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$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 income from all sources (including contributions)2019-12-31$1,058,044
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$341,360
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$338,802
Value of total corrective distributions2019-12-31$1,801
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$342,183
Value of total assets at end of year2019-12-31$4,844,358
Value of total assets at beginning of year2019-12-31$4,127,674
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$757
Total interest from all sources2019-12-31$29,952
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 year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$201,725
Participant contributions at end of year2019-12-31$51,815
Participant contributions at beginning of year2019-12-31$72,024
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$2,373
Administrative expenses (other) incurred2019-12-31$757
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$716,684
Value of net assets at end of year (total assets less liabilities)2019-12-31$4,844,358
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$4,127,674
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$3,893,148
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$3,189,682
Interest on participant loans2019-12-31$3,875
Interest earned on other investments2019-12-31$26,077
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$899,395
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$865,968
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$685,909
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$138,085
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$338,802
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31HESS, STEWART & CAMPBELL, PLLC
Accountancy firm EIN2019-12-31550657218
2018 : SHAWNEE MENTAL HEALTH CTR, INC 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$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$173,218
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$332,724
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$330,527
Expenses. Certain deemed distributions of participant loans2018-12-31$1,290
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$317,728
Value of total assets at end of year2018-12-31$4,127,674
Value of total assets at beginning of year2018-12-31$4,287,180
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$907
Total interest from all sources2018-12-31$30,783
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 year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31No
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$181,361
Participant contributions at end of year2018-12-31$72,024
Participant contributions at beginning of year2018-12-31$45,432
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$5,906
Administrative expenses (other) incurred2018-12-31$907
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-159,506
Value of net assets at end of year (total assets less liabilities)2018-12-31$4,127,674
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$4,287,180
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$3,189,682
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$3,320,424
Interest on participant loans2018-12-31$4,018
Interest earned on other investments2018-12-31$26,765
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$865,968
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$921,324
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-175,293
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$130,461
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$330,527
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31HESS, STEWART & CAMPBELL
Accountancy firm EIN2018-12-31550657218
2017 : SHAWNEE MENTAL HEALTH CTR, INC 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$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$791,499
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$323,034
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$322,029
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$292,749
Value of total assets at end of year2017-12-31$4,287,180
Value of total assets at beginning of year2017-12-31$3,818,715
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$1,005
Total interest from all sources2017-12-31$31,361
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$159,782
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$159,782
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$166,312
Participant contributions at end of year2017-12-31$45,432
Participant contributions at beginning of year2017-12-31$49,915
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$2,372
Administrative expenses (other) incurred2017-12-31$1,005
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$468,465
Value of net assets at end of year (total assets less liabilities)2017-12-31$4,287,180
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$3,818,715
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$3,320,424
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$2,795,994
Interest on participant loans2017-12-31$2,338
Interest earned on other investments2017-12-31$29,023
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$921,324
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$972,806
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$307,607
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$124,065
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$322,029
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31HESS, STEWART & CAMPBELL, PLLC
Accountancy firm EIN2017-12-31550657218
2016 : SHAWNEE MENTAL HEALTH CTR, INC 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$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$494,429
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$314,146
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$313,096
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$268,224
Value of total assets at end of year2016-12-31$3,818,715
Value of total assets at beginning of year2016-12-31$3,638,432
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,050
Total interest from all sources2016-12-31$27,273
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 year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$1,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$152,160
Participant contributions at end of year2016-12-31$49,915
Participant contributions at beginning of year2016-12-31$69,967
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$3,693
Administrative expenses (other) incurred2016-12-31$1,050
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$180,283
Value of net assets at end of year (total assets less liabilities)2016-12-31$3,818,715
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$3,638,432
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$2,795,994
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$2,631,557
Interest on participant loans2016-12-31$216
Interest earned on other investments2016-12-31$27,057
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$972,806
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$936,908
Net investment gain/loss from pooled separate accounts2016-12-31$198,932
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$112,371
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$313,096
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31ABBOTT FINANCIAL SERVICES
Accountancy firm EIN2016-12-31464880293
2015 : SHAWNEE MENTAL HEALTH CTR, INC 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$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$267,297
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$199,233
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$198,239
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$241,188
Value of total assets at end of year2015-12-31$3,638,432
Value of total assets at beginning of year2015-12-31$3,570,368
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$994
Total interest from all sources2015-12-31$24,742
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 year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$161,159
Participant contributions at end of year2015-12-31$69,967
Participant contributions at beginning of year2015-12-31$71,685
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$8,233
Administrative expenses (other) incurred2015-12-31$994
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$68,064
Value of net assets at end of year (total assets less liabilities)2015-12-31$3,638,432
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$3,570,368
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$2,631,557
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$2,882,520
Interest on participant loans2015-12-31$3,390
Interest earned on other investments2015-12-31$21,352
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$936,908
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$616,163
Net investment gain/loss from pooled separate accounts2015-12-31$1,367
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$71,796
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$198,239
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31ABBOTT FINANCIAL SERVICES
Accountancy firm EIN2015-12-31464880293
2014 : SHAWNEE MENTAL HEALTH CTR, INC 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$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$400,147
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$25,521
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$24,616
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$257,117
Value of total assets at end of year2014-12-31$3,570,368
Value of total assets at beginning of year2014-12-31$3,195,742
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$905
Total interest from all sources2014-12-31$20,923
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 year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$1,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Funding deficiency by the employer to the plan for this plan year2014-12-31$0
Minimum employer required contribution for this plan year2014-12-31$0
Amount contributed by the employer to the plan for this plan year2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$179,249
Participant contributions at end of year2014-12-31$71,685
Participant contributions at beginning of year2014-12-31$47,859
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$2,394
Administrative expenses (other) incurred2014-12-31$905
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$374,626
Value of net assets at end of year (total assets less liabilities)2014-12-31$3,570,368
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$3,195,742
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$2,882,520
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$2,588,155
Interest on participant loans2014-12-31$3,423
Interest earned on other investments2014-12-31$17,500
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$616,163
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$559,728
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$122,107
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$75,474
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$24,616
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31ABBOTT FINANCIAL SERVICES
Accountancy firm EIN2014-12-31464880293
2013 : SHAWNEE MENTAL HEALTH CTR, INC 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$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$730,492
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$753,618
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$752,669
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$320,489
Value of total assets at end of year2013-12-31$3,195,742
Value of total assets at beginning of year2013-12-31$3,218,868
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$949
Total interest from all sources2013-12-31$17,689
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 year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$1,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Funding deficiency by the employer to the plan for this plan year2013-12-31$0
Minimum employer required contribution for this plan year2013-12-31$0
Amount contributed by the employer to the plan for this plan year2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$190,959
Participant contributions at end of year2013-12-31$47,859
Participant contributions at beginning of year2013-12-31$49,018
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$53,738
Administrative expenses (other) incurred2013-12-31$949
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-23,126
Value of net assets at end of year (total assets less liabilities)2013-12-31$3,195,742
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$3,218,868
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$2,588,155
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$2,541,724
Interest on participant loans2013-12-31$167
Interest earned on other investments2013-12-31$17,522
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$559,728
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$628,126
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$392,314
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$75,792
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$752,669
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31HAROLD MULLINS CPA, LLC
Accountancy firm EIN2013-12-31273659791
2012 : SHAWNEE MENTAL HEALTH CTR, INC 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$594,788
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$107,165
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$106,287
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$262,975
Value of total assets at end of year2012-12-31$3,218,868
Value of total assets at beginning of year2012-12-31$2,731,245
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$878
Total interest from all sources2012-12-31$22,360
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$1,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$0
Amount contributed by the employer to the plan for this plan year2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$163,283
Participant contributions at end of year2012-12-31$49,018
Participant contributions at beginning of year2012-12-31$65,255
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$34,940
Administrative expenses (other) incurred2012-12-31$878
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$487,623
Value of net assets at end of year (total assets less liabilities)2012-12-31$3,218,868
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$2,731,245
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$2,541,724
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$1,984,922
Interest on participant loans2012-12-31$2,903
Interest earned on other investments2012-12-31$19,457
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$628,126
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$681,068
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$309,453
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$64,752
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$106,287
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31HAROLD MULLINS CPA, LLC
Accountancy firm EIN2012-12-31273659791
2011 : SHAWNEE MENTAL HEALTH CTR, INC 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$155,779
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$197,179
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$196,366
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$223,219
Value of total assets at end of year2011-12-31$2,731,245
Value of total assets at beginning of year2011-12-31$2,772,645
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$813
Total interest from all sources2011-12-31$22,001
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31No
If this is an individual account plan, was there a blackout period2011-12-31No
Funding deficiency by the employer to the plan for this plan year2011-12-31$0
Minimum employer required contribution for this plan year2011-12-31$0
Amount contributed by the employer to the plan for this plan year2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$154,786
Participant contributions at end of year2011-12-31$65,255
Participant contributions at beginning of year2011-12-31$88,274
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$0
Other income not declared elsewhere2011-12-31$-13,812
Administrative expenses (other) incurred2011-12-31$813
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-41,400
Value of net assets at end of year (total assets less liabilities)2011-12-31$2,731,245
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$2,772,645
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$1,984,922
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$2,062,888
Interest on participant loans2011-12-31$4,231
Interest earned on other investments2011-12-31$17,770
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$681,068
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$621,483
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-75,629
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$68,433
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$196,366
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31HAROLD MULLINS CPA, LLC
Accountancy firm EIN2011-12-31273659791
2010 : SHAWNEE MENTAL HEALTH CTR, INC 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$464,130
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$180,662
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$179,664
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$214,767
Value of total assets at end of year2010-12-31$2,772,645
Value of total assets at beginning of year2010-12-31$2,489,177
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$998
Total interest from all sources2010-12-31$22,926
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31No
If this is an individual account plan, was there a blackout period2010-12-31No
Funding deficiency by the employer to the plan for this plan year2010-12-31$0
Minimum employer required contribution for this plan year2010-12-31$0
Amount contributed by the employer to the plan for this plan year2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$158,136
Participant contributions at end of year2010-12-31$88,274
Participant contributions at beginning of year2010-12-31$70,805
Assets. Other investments not covered elsewhere at end of year2010-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$1,480
Other income not declared elsewhere2010-12-31$-1,480
Administrative expenses (other) incurred2010-12-31$998
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$283,468
Value of net assets at end of year (total assets less liabilities)2010-12-31$2,772,645
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,489,177
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$2,062,888
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$1,743,479
Interest on participant loans2010-12-31$4,579
Interest earned on other investments2010-12-31$18,347
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$621,483
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$673,413
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$227,917
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$56,631
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$179,664
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31HAROLD MULLINS, CPA, LLC
Accountancy firm EIN2010-12-31273659791

Form 5500 Responses for SHAWNEE MENTAL HEALTH CTR, INC

2022: SHAWNEE MENTAL HEALTH CTR, INC 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: SHAWNEE MENTAL HEALTH CTR, INC 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: SHAWNEE MENTAL HEALTH CTR, INC 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedYes
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: SHAWNEE MENTAL HEALTH CTR, INC 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: SHAWNEE MENTAL HEALTH CTR, INC 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: SHAWNEE MENTAL HEALTH CTR, INC 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: SHAWNEE MENTAL HEALTH CTR, INC 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: SHAWNEE MENTAL HEALTH CTR, INC 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: SHAWNEE MENTAL HEALTH CTR, INC 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: SHAWNEE MENTAL HEALTH CTR, INC 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: SHAWNEE MENTAL HEALTH CTR, INC 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: SHAWNEE MENTAL HEALTH CTR, INC 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: SHAWNEE MENTAL HEALTH CTR, INC 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number745455-01
Policy instance 1
Insurance contract or identification number745455-01
Number of Individuals Covered46
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,633
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $2,633
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberSHAWNEE
Policy instance 2
Insurance contract or identification numberSHAWNEE
Number of Individuals Covered12
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $16,797
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $16,797
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberSHAWNEE
Policy instance 2
Insurance contract or identification numberSHAWNEE
Number of Individuals Covered12
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered94
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $14,323
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $14,323
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberSHAWNEE
Policy instance 2
Insurance contract or identification numberSHAWNEE
Number of Individuals Covered12
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered94
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $10,291
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $10,291
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberSHAWNEE
Policy instance 2
Insurance contract or identification numberSHAWNEE
Number of Individuals Covered12
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered87
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $9,753
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $9,753
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberSHAWNEE
Policy instance 2
Insurance contract or identification numberSHAWNEE
Number of Individuals Covered12
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered87
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,131
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $13,131
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameAMERIPRISE FINANCIAL SERVICES INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered82
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $9,531
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $9,531
Insurance broker organization code?3
Insurance broker nameAMERIPRISE FINANCIAL SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered81
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $7,178
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $7,178
Insurance broker organization code?3
Insurance broker nameAMERIPRISE FINANCIAL SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered78
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $8,999
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $8,999
Insurance broker organization code?3
Insurance broker nameAMERIPRISE FINANCIAL SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered78
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,927
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $7,927
Insurance broker organization code?3
Insurance broker nameAMERIPRISE FINANCIAL SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered75
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,482
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number000HOORF
Policy instance 3
Insurance contract or identification number000HOORF
Number of Individuals Covered9
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberLI01
Policy instance 2
Insurance contract or identification numberLI01
Number of Individuals Covered22
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751125
Policy instance 1
Insurance contract or identification numberGA-751125
Number of Individuals Covered72
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $17,045
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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

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