COMMUNITY MENTAL HEALTH CENTER, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN
401k plan membership statisitcs for COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $0 |
| Total income from all sources (including contributions) | 2022-06-30 | $2,756,298 |
| Total loss/gain on sale of assets | 2022-06-30 | $0 |
| Total of all expenses incurred | 2022-06-30 | $2,756,298 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-06-30 | $2,529,378 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-06-30 | $2,756,298 |
| Value of total assets at end of year | 2022-06-30 | $0 |
| Value of total assets at beginning of year | 2022-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-06-30 | $226,920 |
| Total interest from all sources | 2022-06-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-06-30 | No |
| Was this plan covered by a fidelity bond | 2022-06-30 | Yes |
| Value of fidelity bond cover | 2022-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-06-30 | No |
| Contributions received from participants | 2022-06-30 | $667,201 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Value of net income/loss | 2022-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2022-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-06-30 | $366,184 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-06-30 | No |
| Contributions received in cash from employer | 2022-06-30 | $2,089,097 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-06-30 | $2,163,194 |
| Contract administrator fees | 2022-06-30 | $226,920 |
| Did the plan have assets held for investment | 2022-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-06-30 | Unqualified |
| Accountancy firm name | 2022-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2022-06-30 | 351178661 |
| 2021 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $0 |
| Total income from all sources (including contributions) | 2021-06-30 | $2,563,447 |
| Total loss/gain on sale of assets | 2021-06-30 | $0 |
| Total of all expenses incurred | 2021-06-30 | $2,563,447 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-06-30 | $2,438,072 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-06-30 | $2,563,447 |
| Value of total assets at end of year | 2021-06-30 | $0 |
| Value of total assets at beginning of year | 2021-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-06-30 | $125,375 |
| Total interest from all sources | 2021-06-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-06-30 | No |
| Was this plan covered by a fidelity bond | 2021-06-30 | Yes |
| Value of fidelity bond cover | 2021-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-06-30 | No |
| Contributions received from participants | 2021-06-30 | $622,232 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-06-30 | No |
| Value of net income/loss | 2021-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2021-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-06-30 | $474,812 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-06-30 | No |
| Contributions received in cash from employer | 2021-06-30 | $1,941,215 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-06-30 | $1,963,260 |
| Contract administrator fees | 2021-06-30 | $125,375 |
| Did the plan have assets held for investment | 2021-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-06-30 | Unqualified |
| Accountancy firm name | 2021-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2021-06-30 | 351178661 |
| 2020 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $0 |
| Total income from all sources (including contributions) | 2020-06-30 | $2,410,232 |
| Total loss/gain on sale of assets | 2020-06-30 | $0 |
| Total of all expenses incurred | 2020-06-30 | $2,410,232 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-06-30 | $2,187,664 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-06-30 | $2,410,232 |
| Value of total assets at end of year | 2020-06-30 | $0 |
| Value of total assets at beginning of year | 2020-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-06-30 | $222,568 |
| Total interest from all sources | 2020-06-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-06-30 | No |
| Was this plan covered by a fidelity bond | 2020-06-30 | Yes |
| Value of fidelity bond cover | 2020-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-06-30 | No |
| Contributions received from participants | 2020-06-30 | $442,740 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
| Value of net income/loss | 2020-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2020-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-06-30 | $535,496 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-06-30 | No |
| Contributions received in cash from employer | 2020-06-30 | $1,967,492 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-06-30 | $1,652,168 |
| Contract administrator fees | 2020-06-30 | $222,568 |
| Did the plan have assets held for investment | 2020-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-06-30 | Unqualified |
| Accountancy firm name | 2020-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2020-06-30 | 351178661 |
| 2019 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $0 |
| Total income from all sources (including contributions) | 2019-06-30 | $2,588,901 |
| Total loss/gain on sale of assets | 2019-06-30 | $0 |
| Total of all expenses incurred | 2019-06-30 | $2,588,901 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-06-30 | $2,439,425 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-06-30 | $2,588,901 |
| Value of total assets at end of year | 2019-06-30 | $0 |
| Value of total assets at beginning of year | 2019-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-06-30 | $149,476 |
| Total interest from all sources | 2019-06-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-06-30 | No |
| Was this plan covered by a fidelity bond | 2019-06-30 | Yes |
| Value of fidelity bond cover | 2019-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-06-30 | No |
| Contributions received from participants | 2019-06-30 | $609,208 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
| Value of net income/loss | 2019-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2019-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-06-30 | $594,437 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-06-30 | No |
| Contributions received in cash from employer | 2019-06-30 | $1,979,693 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-06-30 | $1,844,988 |
| Contract administrator fees | 2019-06-30 | $149,476 |
| Did the plan have assets held for investment | 2019-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-06-30 | Unqualified |
| Accountancy firm name | 2019-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2019-06-30 | 351178661 |
| 2018 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $0 |
| Total income from all sources (including contributions) | 2018-06-30 | $2,516,097 |
| Total loss/gain on sale of assets | 2018-06-30 | $0 |
| Total of all expenses incurred | 2018-06-30 | $2,516,097 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-06-30 | $2,351,660 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-06-30 | $2,516,097 |
| Value of total assets at end of year | 2018-06-30 | $0 |
| Value of total assets at beginning of year | 2018-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-06-30 | $164,437 |
| Total interest from all sources | 2018-06-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-06-30 | No |
| Was this plan covered by a fidelity bond | 2018-06-30 | Yes |
| Value of fidelity bond cover | 2018-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-06-30 | No |
| Contributions received from participants | 2018-06-30 | $613,012 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Value of net income/loss | 2018-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2018-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-06-30 | $510,989 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-06-30 | No |
| Contributions received in cash from employer | 2018-06-30 | $1,903,085 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-06-30 | $1,840,671 |
| Contract administrator fees | 2018-06-30 | $164,437 |
| Did the plan have assets held for investment | 2018-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-06-30 | Unqualified |
| Accountancy firm name | 2018-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2018-06-30 | 351178661 |
| 2017 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $0 |
| Total income from all sources (including contributions) | 2017-06-30 | $2,305,531 |
| Total loss/gain on sale of assets | 2017-06-30 | $0 |
| Total of all expenses incurred | 2017-06-30 | $2,305,531 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-06-30 | $2,161,526 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-06-30 | $2,305,531 |
| Value of total assets at end of year | 2017-06-30 | $0 |
| Value of total assets at beginning of year | 2017-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-06-30 | $144,005 |
| Total interest from all sources | 2017-06-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-06-30 | No |
| Was this plan covered by a fidelity bond | 2017-06-30 | Yes |
| Value of fidelity bond cover | 2017-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-06-30 | No |
| Contributions received from participants | 2017-06-30 | $581,132 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-06-30 | No |
| Value of net income/loss | 2017-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2017-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-06-30 | $416,226 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-06-30 | No |
| Contributions received in cash from employer | 2017-06-30 | $1,724,399 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-06-30 | $1,745,300 |
| Contract administrator fees | 2017-06-30 | $144,005 |
| Did the plan have assets held for investment | 2017-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-06-30 | Unqualified |
| Accountancy firm name | 2017-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2017-06-30 | 351178661 |
| 2016 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $0 |
| Total income from all sources (including contributions) | 2016-06-30 | $2,214,961 |
| Total loss/gain on sale of assets | 2016-06-30 | $0 |
| Total of all expenses incurred | 2016-06-30 | $2,214,961 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-06-30 | $2,065,224 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-06-30 | $2,214,961 |
| Value of total assets at end of year | 2016-06-30 | $0 |
| Value of total assets at beginning of year | 2016-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-06-30 | $149,737 |
| Total interest from all sources | 2016-06-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-06-30 | No |
| Was this plan covered by a fidelity bond | 2016-06-30 | Yes |
| Value of fidelity bond cover | 2016-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-06-30 | No |
| Contributions received from participants | 2016-06-30 | $537,888 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-06-30 | No |
| Value of net income/loss | 2016-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2016-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-06-30 | $354,192 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-06-30 | No |
| Contributions received in cash from employer | 2016-06-30 | $1,677,073 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-06-30 | $1,711,032 |
| Contract administrator fees | 2016-06-30 | $149,737 |
| Did the plan have assets held for investment | 2016-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-06-30 | Unqualified |
| Accountancy firm name | 2016-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2016-06-30 | 351178661 |
| 2015 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-06-30 | $1,590,404 |
| Total of all expenses incurred | 2015-06-30 | $1,590,404 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-06-30 | $1,487,204 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-06-30 | $1,590,404 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-06-30 | $103,200 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-06-30 | No |
| Was this plan covered by a fidelity bond | 2015-06-30 | Yes |
| Value of fidelity bond cover | 2015-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-06-30 | No |
| Contributions received from participants | 2015-06-30 | $519,631 |
| Administrative expenses (other) incurred | 2015-06-30 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-06-30 | No |
| Value of net income/loss | 2015-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-06-30 | $303,752 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-06-30 | No |
| Contributions received in cash from employer | 2015-06-30 | $1,070,773 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-06-30 | $1,183,452 |
| Contract administrator fees | 2015-06-30 | $103,200 |
| Did the plan have assets held for investment | 2015-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-06-30 | Unqualified |
| Accountancy firm name | 2015-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2015-06-30 | 351178661 |
| 2014 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-06-30 | $1,469,861 |
| Total of all expenses incurred | 2014-06-30 | $1,469,861 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-06-30 | $1,324,646 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-06-30 | $1,469,861 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-06-30 | $145,215 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-06-30 | No |
| Was this plan covered by a fidelity bond | 2014-06-30 | Yes |
| Value of fidelity bond cover | 2014-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-06-30 | No |
| Contributions received from participants | 2014-06-30 | $529,411 |
| Administrative expenses (other) incurred | 2014-06-30 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-06-30 | No |
| Value of net income/loss | 2014-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-06-30 | $332,294 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-06-30 | No |
| Contributions received in cash from employer | 2014-06-30 | $940,450 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-06-30 | $992,352 |
| Contract administrator fees | 2014-06-30 | $145,215 |
| Did the plan have assets held for investment | 2014-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-06-30 | Unqualified |
| Accountancy firm name | 2014-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2014-06-30 | 351178661 |
| 2013 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-06-30 | $1,347,074 |
| Total of all expenses incurred | 2013-06-30 | $1,347,074 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-06-30 | $1,240,515 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-06-30 | $1,347,074 |
| Value of total assets at beginning of year | 2013-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-06-30 | $106,559 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-06-30 | No |
| Was this plan covered by a fidelity bond | 2013-06-30 | Yes |
| Value of fidelity bond cover | 2013-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-06-30 | No |
| Contributions received from participants | 2013-06-30 | $556,740 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Value of net income/loss | 2013-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-06-30 | $353,715 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-06-30 | No |
| Contributions received in cash from employer | 2013-06-30 | $790,334 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-06-30 | $886,800 |
| Contract administrator fees | 2013-06-30 | $106,559 |
| Did the plan have assets held for investment | 2013-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-06-30 | Unqualified |
| Accountancy firm name | 2013-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2013-06-30 | 351178661 |
| 2012 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-06-30 | $1,269,210 |
| Total of all expenses incurred | 2012-06-30 | $1,269,210 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-06-30 | $1,162,562 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-06-30 | $1,269,210 |
| Value of total assets at end of year | 2012-06-30 | $0 |
| Value of total assets at beginning of year | 2012-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-06-30 | $106,648 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-06-30 | No |
| Was this plan covered by a fidelity bond | 2012-06-30 | Yes |
| Value of fidelity bond cover | 2012-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-06-30 | No |
| Contributions received from participants | 2012-06-30 | $534,986 |
| Total non interest bearing cash at end of year | 2012-06-30 | $0 |
| Total non interest bearing cash at beginning of year | 2012-06-30 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Value of net income/loss | 2012-06-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2012-06-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-06-30 | $263,444 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-06-30 | No |
| Contributions received in cash from employer | 2012-06-30 | $734,224 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-06-30 | $899,118 |
| Contract administrator fees | 2012-06-30 | $106,648 |
| Did the plan have assets held for investment | 2012-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-06-30 | Unqualified |
| Accountancy firm name | 2012-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2012-06-30 | 351178661 |
| 2011 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-06-30 | $1,607,260 |
| Total of all expenses incurred | 2011-06-30 | $1,607,260 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-06-30 | $1,510,444 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-06-30 | $1,607,260 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-06-30 | $96,816 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-06-30 | No |
| Was this plan covered by a fidelity bond | 2011-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-06-30 | No |
| Contributions received from participants | 2011-06-30 | $518,093 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Value of net income/loss | 2011-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-06-30 | $323,704 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-06-30 | No |
| Contributions received in cash from employer | 2011-06-30 | $1,089,167 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-06-30 | $1,186,740 |
| Contract administrator fees | 2011-06-30 | $96,816 |
| Did the plan have assets held for investment | 2011-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-06-30 | Unqualified |
| Accountancy firm name | 2011-06-30 | BLUE & CO LLC |
| Accountancy firm EIN | 2011-06-30 | 351178661 |
| 2007 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2007 401k financial data |
|---|
| Total income from all sources | 2007-06-30 | $1,184,799 |
| Expenses. Total of all expenses incurred | 2007-06-30 | $1,181,772 |
| Benefits paid (including direct rollovers) | 2007-06-30 | $1,057,056 |
| Total plan assets at end of year | 2007-06-30 | $5,435 |
| Total plan assets at beginning of year | 2007-06-30 | $2,408 |
| Total contributions received or receivable from participants | 2007-06-30 | $313,567 |
| Expenses. Other expenses not covered elsewhere | 2007-06-30 | $124,716 |
| Net income (gross income less expenses) | 2007-06-30 | $3,027 |
| Net plan assets at end of year (total assets less liabilities) | 2007-06-30 | $5,435 |
| Net plan assets at beginning of year (total assets less liabilities) | 2007-06-30 | $2,408 |
| Total contributions received or receivable from employer(s) | 2007-06-30 | $871,232 |
| 2006 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2006 401k financial data |
|---|
| Total income from all sources | 2006-06-30 | $1,270,982 |
| Expenses. Total of all expenses incurred | 2006-06-30 | $1,271,416 |
| Benefits paid (including direct rollovers) | 2006-06-30 | $1,160,838 |
| Total plan assets at end of year | 2006-06-30 | $2,407 |
| Total plan assets at beginning of year | 2006-06-30 | $2,841 |
| Total contributions received or receivable from participants | 2006-06-30 | $310,745 |
| Expenses. Other expenses not covered elsewhere | 2006-06-30 | $110,578 |
| Net income (gross income less expenses) | 2006-06-30 | $-434 |
| Net plan assets at end of year (total assets less liabilities) | 2006-06-30 | $2,407 |
| Net plan assets at beginning of year (total assets less liabilities) | 2006-06-30 | $2,841 |
| Total contributions received or receivable from employer(s) | 2006-06-30 | $960,237 |
| 2005 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2005 401k financial data |
|---|
| Total income from all sources | 2005-06-30 | $1,017,105 |
| Expenses. Total of all expenses incurred | 2005-06-30 | $1,018,080 |
| Benefits paid (including direct rollovers) | 2005-06-30 | $922,717 |
| Total plan assets at end of year | 2005-06-30 | $2,840 |
| Total plan assets at beginning of year | 2005-06-30 | $3,815 |
| Total contributions received or receivable from participants | 2005-06-30 | $237,332 |
| Expenses. Other expenses not covered elsewhere | 2005-06-30 | $95,363 |
| Net income (gross income less expenses) | 2005-06-30 | $-975 |
| Net plan assets at end of year (total assets less liabilities) | 2005-06-30 | $2,840 |
| Net plan assets at beginning of year (total assets less liabilities) | 2005-06-30 | $3,815 |
| Total contributions received or receivable from employer(s) | 2005-06-30 | $779,773 |
| 2004 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2004 401k financial data |
|---|
| Total income from all sources | 2004-06-30 | $819,655 |
| Expenses. Total of all expenses incurred | 2004-06-30 | $818,799 |
| Benefits paid (including direct rollovers) | 2004-06-30 | $733,695 |
| Total plan assets at end of year | 2004-06-30 | $3,815 |
| Total plan assets at beginning of year | 2004-06-30 | $2,959 |
| Total contributions received or receivable from participants | 2004-06-30 | $186,104 |
| Expenses. Other expenses not covered elsewhere | 2004-06-30 | $85,104 |
| Net income (gross income less expenses) | 2004-06-30 | $856 |
| Net plan assets at end of year (total assets less liabilities) | 2004-06-30 | $3,815 |
| Net plan assets at beginning of year (total assets less liabilities) | 2004-06-30 | $2,959 |
| Total contributions received or receivable from employer(s) | 2004-06-30 | $633,551 |
| 2003 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2003 401k financial data |
|---|
| Total income from all sources | 2003-06-30 | $531,398 |
| Expenses. Total of all expenses incurred | 2003-06-30 | $530,463 |
| Benefits paid (including direct rollovers) | 2003-06-30 | $491,857 |
| Total plan assets at end of year | 2003-06-30 | $2,959 |
| Total plan assets at beginning of year | 2003-06-30 | $2,024 |
| Total contributions received or receivable from participants | 2003-06-30 | $159,521 |
| Expenses. Other expenses not covered elsewhere | 2003-06-30 | $38,606 |
| Net income (gross income less expenses) | 2003-06-30 | $935 |
| Net plan assets at end of year (total assets less liabilities) | 2003-06-30 | $2,959 |
| Net plan assets at beginning of year (total assets less liabilities) | 2003-06-30 | $2,024 |
| Total contributions received or receivable from employer(s) | 2003-06-30 | $371,877 |
| 2002 : COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2002 401k financial data |
|---|
| Total income from all sources | 2002-06-30 | $385,855 |
| Expenses. Total of all expenses incurred | 2002-06-30 | $386,776 |
| Benefits paid (including direct rollovers) | 2002-06-30 | $356,528 |
| Total plan assets at end of year | 2002-06-30 | $2,024 |
| Total plan assets at beginning of year | 2002-06-30 | $2,945 |
| Total contributions received or receivable from participants | 2002-06-30 | $131,790 |
| Expenses. Other expenses not covered elsewhere | 2002-06-30 | $30,248 |
| Net income (gross income less expenses) | 2002-06-30 | $-921 |
| Net plan assets at end of year (total assets less liabilities) | 2002-06-30 | $2,024 |
| Net plan assets at beginning of year (total assets less liabilities) | 2002-06-30 | $2,945 |
| Total contributions received or receivable from employer(s) | 2002-06-30 | $254,065 |
| 2021: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Submission has been amended | No |
| 2021-07-01 | This submission is the final filing | No |
| 2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-07-01 | Plan is a collectively bargained plan | No |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan funding arrangement – Trust | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement - Trust | Yes |
| 2020: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Submission has been amended | No |
| 2020-07-01 | This submission is the final filing | No |
| 2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-07-01 | Plan is a collectively bargained plan | No |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan funding arrangement – Trust | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement - Trust | Yes |
| 2019: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Submission has been amended | No |
| 2019-07-01 | This submission is the final filing | No |
| 2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-07-01 | Plan is a collectively bargained plan | No |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan funding arrangement – Trust | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement - Trust | Yes |
| 2018: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Submission has been amended | No |
| 2018-07-01 | This submission is the final filing | No |
| 2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-07-01 | Plan is a collectively bargained plan | No |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan funding arrangement – Trust | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement - Trust | Yes |
| 2017: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Submission has been amended | No |
| 2017-07-01 | This submission is the final filing | No |
| 2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-07-01 | Plan is a collectively bargained plan | No |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan funding arrangement – Trust | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement - Trust | Yes |
| 2016: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Submission has been amended | No |
| 2016-07-01 | This submission is the final filing | No |
| 2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-07-01 | Plan is a collectively bargained plan | No |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan funding arrangement – Trust | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement - Trust | Yes |
| 2015: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – Trust | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement - Trust | Yes |
| 2014: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – Trust | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement - Trust | Yes |
| 2013: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – Trust | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement - Trust | Yes |
| 2012: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – Trust | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement - Trust | Yes |
| 2011: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – Trust | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement - Trust | Yes |
| 2010: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Submission has been amended | No |
| 2010-07-01 | This submission is the final filing | No |
| 2010-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-07-01 | Plan is a collectively bargained plan | No |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan funding arrangement – Trust | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement - Trust | Yes |
| 2009: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2006 form 5500 responses |
|---|
| 2006-07-01 | Type of plan entity | Single employer plan |
| 2006-07-01 | Submission has been amended | Yes |
| 2006-07-01 | This submission is the final filing | No |
| 2006-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-07-01 | Plan is a collectively bargained plan | No |
| 2006-07-01 | Plan funding arrangement – Insurance | Yes |
| 2006-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2006-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2005 form 5500 responses |
|---|
| 2005-07-01 | Type of plan entity | Single employer plan |
| 2005-07-01 | Submission has been amended | Yes |
| 2005-07-01 | This submission is the final filing | No |
| 2005-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-07-01 | Plan is a collectively bargained plan | No |
| 2005-07-01 | Plan funding arrangement – Insurance | Yes |
| 2005-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2005-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2003: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2003 form 5500 responses |
|---|
| 2003-07-01 | Type of plan entity | Single employer plan |
| 2003-07-01 | Submission has been amended | Yes |
| 2003-07-01 | This submission is the final filing | No |
| 2003-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-07-01 | Plan is a collectively bargained plan | No |
| 2003-07-01 | Plan funding arrangement – Insurance | Yes |
| 2003-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2003-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2003-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2002: COMMUNITY MENTAL HEALTH CENTER, INC. BENEFIT PLAN 2002 form 5500 responses |
|---|
| 2002-07-01 | Type of plan entity | Single employer plan |
| 2002-07-01 | Submission has been amended | Yes |
| 2002-07-01 | This submission is the final filing | No |
| 2002-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-07-01 | Plan is a collectively bargained plan | No |
| 2002-07-01 | Plan funding arrangement – Insurance | Yes |
| 2002-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2002-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2002-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10254291/2/3 |
| Policy instance | 2 |
| Insurance contract or identification number | 10254291/2/3 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $7,123 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $121,863 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5145 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417007410984 |
| Policy instance | 1 |
| Insurance contract or identification number | 417007410984 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98512541001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98512541001 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417011410984 |
| Policy instance | 4 |
| Insurance contract or identification number | 417011410984 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $231,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98512541001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98512541001 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $1,303 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,303 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417007410984 |
| Policy instance | 1 |
| Insurance contract or identification number | 417007410984 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $1,821 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,570 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10254291/2/3 |
| Policy instance | 2 |
| Insurance contract or identification number | 10254291/2/3 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $18,038 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $120,257 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,743 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417011410984 |
| Policy instance | 4 |
| Insurance contract or identification number | 417011410984 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $336,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 913104 |
| Policy instance | 4 |
| Insurance contract or identification number | 913104 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $61,209 | | Total amount of fees paid to insurance company | USD $2,493 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $407,696 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,209 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2493 | | Additional information about fees paid to insurance broker | BONUS |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98512541001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98512541001 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $952 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $952 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10254291 |
| Policy instance | 2 |
| Insurance contract or identification number | 10254291 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $17,112 | | Total amount of fees paid to insurance company | USD $4,849 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $114,083 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,112 | | Amount paid for insurance broker fees | 4849 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417007410984 |
| Policy instance | 1 |
| Insurance contract or identification number | 417007410984 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $1,372 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,717 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,372 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98512541001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98512541001 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $1,147 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,429 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,147 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B72H |
| Policy instance | 2 |
| Insurance contract or identification number | G000B72H | | Number of Individuals Covered | 227 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $20,375 | | Total amount of fees paid to insurance company | USD $9,328 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $135,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,375 | | Amount paid for insurance broker fees | 9328 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417007410984 |
| Policy instance | 1 |
| Insurance contract or identification number | 417007410984 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $1,330 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $77,807 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,330 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98512541001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98512541001 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,057 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,547 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B72H |
| Policy instance | 2 |
| Insurance contract or identification number | G000B72H | | Number of Individuals Covered | 221 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $19,836 | | Total amount of fees paid to insurance company | USD $8,551 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $132,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417007410984 |
| Policy instance | 1 |
| Insurance contract or identification number | 417007410984 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,365 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,652 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417007410984 |
| Policy instance | 1 |
| Insurance contract or identification number | 417007410984 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $1,726 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,590 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05986246 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05986246 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $13,757 | | Total amount of fees paid to insurance company | USD $2,345 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $110,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,652 | | Amount paid for insurance broker fees | 24 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INS SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05986246 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05986246 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $8,778 | | Total amount of fees paid to insurance company | USD $1,039 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $58,610 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,778 | | Amount paid for insurance broker fees | 15 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 4017008410984 |
| Policy instance | 3 |
| Insurance contract or identification number | 4017008410984 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2014-07-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $217,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417007410984 |
| Policy instance | 1 |
| Insurance contract or identification number | 417007410984 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $1,798 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $17,987 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,798 | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417006410984 |
| Policy instance | 3 |
| Insurance contract or identification number | 417006410984 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $36,909 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $244,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,909 | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05986246 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05986246 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $8,422 | | Total amount of fees paid to insurance company | USD $842 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $60,912 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,422 | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC. |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417007410984 |
| Policy instance | 1 |
| Insurance contract or identification number | 417007410984 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $1,815 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $18,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,815 | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-3437 |
| Policy instance | 1 |
| Insurance contract or identification number | 949-3437 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $2,342 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $23,422 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,342 | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05986246 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05986246 | | Number of Individuals Covered | 302 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $10,513 | | Total amount of fees paid to insurance company | USD $2,378 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $64,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,513 | | Amount paid for insurance broker fees | 34 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC. |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-1588 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-1588 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $39,201 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $257,981 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,201 | | Insurance broker organization code? | 3 | | Insurance broker name | USI MIDWEST INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 004000010008741 |
| Policy instance | 3 |
| Insurance contract or identification number | 004000010008741 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $852 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $5,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 417004410984 |
| Policy instance | 6 |
| Insurance contract or identification number | 417004410984 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $237,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 001010698100000 |
| Policy instance | 5 |
| Insurance contract or identification number | 001010698100000 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $615 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $6,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 001010698200000 |
| Policy instance | 4 |
| Insurance contract or identification number | 001010698200000 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $1,450 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05986246 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05986246 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $5,391 | | Total amount of fees paid to insurance company | USD $2,044 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $41,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 9490419 |
| Policy instance | 1 |
| Insurance contract or identification number | 9490419 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $2,150 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $21,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 280-8427 |
| Policy instance | 5 |
| Insurance contract or identification number | 280-8427 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $1,568 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $17,267 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 280-9679 |
| Policy instance | 4 |
| Insurance contract or identification number | 280-9679 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $19,813 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $217,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 001010698100000 |
| Policy instance | 3 |
| Insurance contract or identification number | 001010698100000 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2010-07-01 | | Total amount of commissions paid to insurance broker | USD $1,794 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $17,939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 004000010008741 |
| Policy instance | 1 |
| Insurance contract or identification number | 004000010008741 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $2,567 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $17,115 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 001010698200000 |
| Policy instance | 2 |
| Insurance contract or identification number | 001010698200000 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $4,539 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CL976 |
| Policy instance | 2 |
| Insurance contract or identification number | CL976 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2001-07-01 | | Insurance policy end date | 2002-06-30 | | Total amount of commissions paid to insurance broker | USD $434 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $434 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000121720 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000121720 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2006-07-01 | | Insurance policy end date | 2007-06-30 | | Total amount of commissions paid to insurance broker | USD $4,121 | | Health Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,617 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,121 | | Insurance broker organization code? | 3 | | Insurance broker name | MICHAEL KRAMER |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | 10283 |
| Policy instance | 1 |
| Insurance contract or identification number | 10283 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2006-07-01 | | Insurance policy end date | 2007-06-30 | | Total amount of commissions paid to insurance broker | USD $21,708 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $236,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,698 | | Insurance broker organization code? | 3 | | Insurance broker name | MEDICAL BENEFITS ADMINISTRATORS |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CL976 |
| Policy instance | 2 |
| Insurance contract or identification number | CL976 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2006-07-01 | | Insurance policy end date | 2007-06-30 | | Total amount of commissions paid to insurance broker | USD $1,225 | | Health Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,092 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,225 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CL976 |
| Policy instance | 2 |
| Insurance contract or identification number | CL976 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2005-07-01 | | Insurance policy end date | 2006-06-30 | | Total amount of commissions paid to insurance broker | USD $727 | | Health Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,900 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $727 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 10283 |
| Policy instance | 1 |
| Insurance contract or identification number | 10283 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2005-07-01 | | Insurance policy end date | 2006-06-30 | | Total amount of commissions paid to insurance broker | USD $12,373 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $204,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,373 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
|
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G187131 |
| Policy instance | 3 |
| Insurance contract or identification number | G187131 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2005-07-01 | | Insurance policy end date | 2006-06-30 | | Total amount of commissions paid to insurance broker | USD $6,221 | | Health Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,085 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,631 | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN INSURNET AGENCY |
|
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G187131 |
| Policy instance | 3 |
| Insurance contract or identification number | G187131 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2004-07-01 | | Insurance policy end date | 2005-06-30 | | Total amount of commissions paid to insurance broker | USD $4,884 | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,884 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 10283 |
| Policy instance | 1 |
| Insurance contract or identification number | 10283 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2004-07-01 | | Insurance policy end date | 2005-06-30 | | Total amount of commissions paid to insurance broker | USD $12,373 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $171,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,373 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CL976 |
| Policy instance | 2 |
| Insurance contract or identification number | CL976 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2004-07-01 | | Insurance policy end date | 2005-06-30 | | Total amount of commissions paid to insurance broker | USD $559 | | Health Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,183 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $559 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
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| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 048-5810-00 |
| Policy instance | 1 |
| Insurance contract or identification number | 048-5810-00 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2003-07-01 | | Insurance policy end date | 2004-06-30 | | Total amount of commissions paid to insurance broker | USD $15,871 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $111,621 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,871 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CL976 |
| Policy instance | 2 |
| Insurance contract or identification number | CL976 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2003-07-01 | | Insurance policy end date | 2004-06-30 | | Total amount of commissions paid to insurance broker | USD $475 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $475 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
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| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G187131 |
| Policy instance | 3 |
| Insurance contract or identification number | G187131 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2003-07-01 | | Insurance policy end date | 2004-06-30 | | Total amount of commissions paid to insurance broker | USD $4,884 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,884 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
|
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G187131 |
| Policy instance | 3 |
| Insurance contract or identification number | G187131 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2002-07-01 | | Insurance policy end date | 2003-06-30 | | Total amount of commissions paid to insurance broker | USD $4,884 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,504 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,884 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
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| GE GROUP LIFE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 048-5810-00 |
| Policy instance | 1 |
| Insurance contract or identification number | 048-5810-00 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2002-07-01 | | Insurance policy end date | 2003-06-30 | | Total amount of commissions paid to insurance broker | USD $8,070 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,070 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | CL976 |
| Policy instance | 2 |
| Insurance contract or identification number | CL976 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2002-07-01 | | Insurance policy end date | 2003-06-30 | | Total amount of commissions paid to insurance broker | USD $560 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,529 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $560 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
|
| GE GROUP LIFE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 048-5810-00 |
| Policy instance | 1 |
| Insurance contract or identification number | 048-5810-00 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2001-07-01 | | Insurance policy end date | 2002-06-30 | | Total amount of commissions paid to insurance broker | USD $6,873 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,891 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6873 | | Insurance broker organization code? | 3 | | Insurance broker name | PINNACLE ADVISORY GROUP |
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