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FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 401k Plan overview

Plan NameFOUR COUNTY EMPLOYEE HEALTH CARE PLAN
Plan identification number 501

FOUR COUNTY EMPLOYEE HEALTH CARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER INC DBA 4C HEALTH has sponsored the creation of one or more 401k plans.

Company Name:FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER INC DBA 4C HEALTH
Employer identification number (EIN):351362298
NAIC Classification:621330
NAIC Description:Offices of Mental Health Practitioners (except Physicians)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOUR COUNTY EMPLOYEE HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01
5012020-11-01
5012019-11-01
5012018-11-01
5012017-11-01
5012016-11-01DIANA ELLIOTT
5012015-11-01DIANA ELLIOTT
5012014-11-01DIANA ELLIOTT
5012013-11-01DIANA ELLIOTT DIANA ELLIOTT2015-08-17
5012012-11-01DIANA ELLIOTT DIANA ELLIOTT2014-08-13
5012011-11-01DIANA ELLIOTT DIANA ELLIOTT2013-08-09
5012010-11-01CARL DAVIS JR CARL DAVIS JR2012-08-15
5012009-11-01LAWRENCE ULRICH LAWRENCE ULRICH2011-08-12

Plan Statistics for FOUR COUNTY EMPLOYEE HEALTH CARE PLAN

401k plan membership statisitcs for FOUR COUNTY EMPLOYEE HEALTH CARE PLAN

Measure Date Value
2021: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-01197
Total number of active participants reported on line 7a of the Form 55002021-11-01187
Number of retired or separated participants receiving benefits2021-11-010
Number of other retired or separated participants entitled to future benefits2021-11-010
Total of all active and inactive participants2021-11-01187
2020: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-01186
Total number of active participants reported on line 7a of the Form 55002020-11-01208
Number of retired or separated participants receiving benefits2020-11-010
Number of other retired or separated participants entitled to future benefits2020-11-010
Total of all active and inactive participants2020-11-01208
2019: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01186
Total number of active participants reported on line 7a of the Form 55002019-11-01185
Number of retired or separated participants receiving benefits2019-11-010
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-01185
2018: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01160
Total number of active participants reported on line 7a of the Form 55002018-11-01187
Number of retired or separated participants receiving benefits2018-11-010
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-01187
2017: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01182
Total number of active participants reported on line 7a of the Form 55002017-11-01160
Number of retired or separated participants receiving benefits2017-11-010
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-01160
2016: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01185
Total number of active participants reported on line 7a of the Form 55002016-11-01182
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01182
2015: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01161
Total number of active participants reported on line 7a of the Form 55002015-11-01185
Number of retired or separated participants receiving benefits2015-11-010
Number of other retired or separated participants entitled to future benefits2015-11-010
Total of all active and inactive participants2015-11-01185
2014: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01164
Total number of active participants reported on line 7a of the Form 55002014-11-01161
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-010
Total of all active and inactive participants2014-11-01161
2013: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01173
Total number of active participants reported on line 7a of the Form 55002013-11-01164
Total of all active and inactive participants2013-11-01164
2012: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-01159
Total number of active participants reported on line 7a of the Form 55002012-11-01173
Total of all active and inactive participants2012-11-01173
2011: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-01164
Total number of active participants reported on line 7a of the Form 55002011-11-01159
Total of all active and inactive participants2011-11-01159
2010: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-01161
Total number of active participants reported on line 7a of the Form 55002010-11-01162
Number of retired or separated participants receiving benefits2010-11-012
Total of all active and inactive participants2010-11-01164
2009: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-01162
Total number of active participants reported on line 7a of the Form 55002009-11-01160
Number of retired or separated participants receiving benefits2009-11-011
Number of other retired or separated participants entitled to future benefits2009-11-010
Total of all active and inactive participants2009-11-01161
Total participants2009-11-010

Financial Data on FOUR COUNTY EMPLOYEE HEALTH CARE PLAN

Measure Date Value
2022 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-10-31$0
Total income from all sources (including contributions)2022-10-31$2,361,195
Total loss/gain on sale of assets2022-10-31$0
Total of all expenses incurred2022-10-31$2,361,195
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-10-31$2,151,022
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-10-31$2,361,195
Value of total assets at end of year2022-10-31$0
Value of total assets at beginning of year2022-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-10-31$210,173
Total interest from all sources2022-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-10-31No
Was this plan covered by a fidelity bond2022-10-31Yes
Value of fidelity bond cover2022-10-31$8,000,000
Were there any nonexempt tranactions with any party-in-interest2022-10-31No
Contributions received from participants2022-10-31$636,440
Administrative expenses (other) incurred2022-10-31$210,173
Total non interest bearing cash at end of year2022-10-31$0
Total non interest bearing cash at beginning of year2022-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-10-31No
Value of net income/loss2022-10-31$0
Value of net assets at end of year (total assets less liabilities)2022-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2022-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-10-31No
Were any leases to which the plan was party in default or uncollectible2022-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-10-31$510,612
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-10-31No
Was there a failure to transmit to the plan any participant contributions2022-10-31No
Has the plan failed to provide any benefit when due under the plan2022-10-31No
Contributions received in cash from employer2022-10-31$1,724,755
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-10-31$1,640,410
Did the plan have assets held for investment2022-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-10-31No
Opinion of an independent qualified public accountant for this plan2022-10-31Unqualified
Accountancy firm name2022-10-31BLUE & CO, LLC
Accountancy firm EIN2022-10-31351178661
2021 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-10-31$0
Total income from all sources (including contributions)2021-10-31$2,800,909
Total loss/gain on sale of assets2021-10-31$0
Total of all expenses incurred2021-10-31$2,800,909
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-10-31$2,601,661
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-10-31$2,800,909
Value of total assets at end of year2021-10-31$0
Value of total assets at beginning of year2021-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-10-31$199,248
Total interest from all sources2021-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-10-31No
Was this plan covered by a fidelity bond2021-10-31Yes
Value of fidelity bond cover2021-10-31$8,000,000
Were there any nonexempt tranactions with any party-in-interest2021-10-31No
Contributions received from participants2021-10-31$675,183
Administrative expenses (other) incurred2021-10-31$199,248
Total non interest bearing cash at end of year2021-10-31$0
Total non interest bearing cash at beginning of year2021-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-10-31No
Value of net income/loss2021-10-31$0
Value of net assets at end of year (total assets less liabilities)2021-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2021-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-10-31No
Were any leases to which the plan was party in default or uncollectible2021-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-10-31$541,787
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-10-31No
Was there a failure to transmit to the plan any participant contributions2021-10-31No
Has the plan failed to provide any benefit when due under the plan2021-10-31No
Contributions received in cash from employer2021-10-31$2,125,726
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-10-31$2,059,874
Did the plan have assets held for investment2021-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-10-31No
Opinion of an independent qualified public accountant for this plan2021-10-31Unqualified
Accountancy firm name2021-10-31BLUE & CO, LLC
Accountancy firm EIN2021-10-31351178661
2020 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-10-31$0
Total income from all sources (including contributions)2020-10-31$2,227,918
Total loss/gain on sale of assets2020-10-31$0
Total of all expenses incurred2020-10-31$2,227,918
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-10-31$2,013,315
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-10-31$2,227,918
Value of total assets at end of year2020-10-31$0
Value of total assets at beginning of year2020-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-10-31$214,603
Total interest from all sources2020-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-10-31No
Was this plan covered by a fidelity bond2020-10-31Yes
Value of fidelity bond cover2020-10-31$8,000,000
Were there any nonexempt tranactions with any party-in-interest2020-10-31No
Contributions received from participants2020-10-31$759,633
Administrative expenses (other) incurred2020-10-31$214,603
Total non interest bearing cash at end of year2020-10-31$0
Total non interest bearing cash at beginning of year2020-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-10-31No
Value of net income/loss2020-10-31$0
Value of net assets at end of year (total assets less liabilities)2020-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2020-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-10-31No
Were any leases to which the plan was party in default or uncollectible2020-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-10-31$480,387
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-10-31No
Was there a failure to transmit to the plan any participant contributions2020-10-31No
Has the plan failed to provide any benefit when due under the plan2020-10-31No
Contributions received in cash from employer2020-10-31$1,468,285
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-10-31$1,532,928
Did the plan have assets held for investment2020-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-10-31No
Opinion of an independent qualified public accountant for this plan2020-10-31Unqualified
Accountancy firm name2020-10-31BLUE & CO, LLC
Accountancy firm EIN2020-10-31351178661
2019 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-10-31$0
Total income from all sources (including contributions)2019-10-31$1,931,650
Total loss/gain on sale of assets2019-10-31$0
Total of all expenses incurred2019-10-31$1,931,650
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-10-31$1,752,002
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-10-31$1,931,650
Value of total assets at end of year2019-10-31$0
Value of total assets at beginning of year2019-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-10-31$179,648
Total interest from all sources2019-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-10-31No
Was this plan covered by a fidelity bond2019-10-31Yes
Value of fidelity bond cover2019-10-31$8,000,000
Were there any nonexempt tranactions with any party-in-interest2019-10-31No
Contributions received from participants2019-10-31$620,580
Administrative expenses (other) incurred2019-10-31$179,648
Total non interest bearing cash at end of year2019-10-31$0
Total non interest bearing cash at beginning of year2019-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-10-31No
Value of net income/loss2019-10-31$0
Value of net assets at end of year (total assets less liabilities)2019-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2019-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-10-31No
Were any leases to which the plan was party in default or uncollectible2019-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-10-31$402,061
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-10-31No
Was there a failure to transmit to the plan any participant contributions2019-10-31No
Has the plan failed to provide any benefit when due under the plan2019-10-31No
Contributions received in cash from employer2019-10-31$1,311,070
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-10-31$1,349,941
Did the plan have assets held for investment2019-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-10-31No
Opinion of an independent qualified public accountant for this plan2019-10-31Unqualified
Accountancy firm name2019-10-31BLUE & CO, LLC
Accountancy firm EIN2019-10-31351178661
2018 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-10-31$0
Total income from all sources (including contributions)2018-10-31$2,011,999
Total loss/gain on sale of assets2018-10-31$0
Total of all expenses incurred2018-10-31$2,011,999
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-10-31$1,819,356
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-10-31$2,011,999
Value of total assets at end of year2018-10-31$0
Value of total assets at beginning of year2018-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-10-31$192,643
Total interest from all sources2018-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-10-31No
Was this plan covered by a fidelity bond2018-10-31Yes
Value of fidelity bond cover2018-10-31$8,000,000
Were there any nonexempt tranactions with any party-in-interest2018-10-31No
Contributions received from participants2018-10-31$655,246
Administrative expenses (other) incurred2018-10-31$192,643
Total non interest bearing cash at end of year2018-10-31$0
Total non interest bearing cash at beginning of year2018-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-10-31No
Value of net income/loss2018-10-31$0
Value of net assets at end of year (total assets less liabilities)2018-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2018-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-10-31No
Were any leases to which the plan was party in default or uncollectible2018-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-10-31$394,091
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-10-31No
Was there a failure to transmit to the plan any participant contributions2018-10-31No
Has the plan failed to provide any benefit when due under the plan2018-10-31No
Contributions received in cash from employer2018-10-31$1,356,753
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-10-31$1,425,265
Did the plan have assets held for investment2018-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-10-31No
Opinion of an independent qualified public accountant for this plan2018-10-31Unqualified
Accountancy firm name2018-10-31BLUE & CO, LLC
Accountancy firm EIN2018-10-31351178661
2017 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-10-31$0
Total income from all sources (including contributions)2017-10-31$2,272,071
Total loss/gain on sale of assets2017-10-31$0
Total of all expenses incurred2017-10-31$2,272,071
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-10-31$2,050,032
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-10-31$2,272,071
Value of total assets at end of year2017-10-31$0
Value of total assets at beginning of year2017-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-10-31$222,039
Total interest from all sources2017-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-10-31No
Was this plan covered by a fidelity bond2017-10-31Yes
Value of fidelity bond cover2017-10-31$4,000,000
Were there any nonexempt tranactions with any party-in-interest2017-10-31No
Contributions received from participants2017-10-31$703,498
Administrative expenses (other) incurred2017-10-31$222,039
Total non interest bearing cash at end of year2017-10-31$0
Total non interest bearing cash at beginning of year2017-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-10-31No
Value of net income/loss2017-10-31$0
Value of net assets at end of year (total assets less liabilities)2017-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2017-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-10-31No
Were any leases to which the plan was party in default or uncollectible2017-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-10-31$429,646
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-10-31No
Was there a failure to transmit to the plan any participant contributions2017-10-31No
Has the plan failed to provide any benefit when due under the plan2017-10-31No
Contributions received in cash from employer2017-10-31$1,568,573
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-10-31$1,620,386
Did the plan have assets held for investment2017-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-10-31No
Opinion of an independent qualified public accountant for this plan2017-10-31Unqualified
Accountancy firm name2017-10-31BLUE & CO, LLC
Accountancy firm EIN2017-10-31351178661
2016 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-10-31$0
Total income from all sources (including contributions)2016-10-31$1,417,381
Total loss/gain on sale of assets2016-10-31$0
Total of all expenses incurred2016-10-31$1,417,381
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-10-31$1,214,479
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-10-31$1,417,381
Value of total assets at end of year2016-10-31$0
Value of total assets at beginning of year2016-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-10-31$202,902
Total interest from all sources2016-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-10-31No
Was this plan covered by a fidelity bond2016-10-31Yes
Value of fidelity bond cover2016-10-31$4,000,000
Were there any nonexempt tranactions with any party-in-interest2016-10-31No
Contributions received from participants2016-10-31$593,034
Administrative expenses (other) incurred2016-10-31$202,902
Total non interest bearing cash at end of year2016-10-31$0
Total non interest bearing cash at beginning of year2016-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-10-31No
Value of net income/loss2016-10-31$0
Value of net assets at end of year (total assets less liabilities)2016-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2016-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-10-31No
Were any leases to which the plan was party in default or uncollectible2016-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-10-31$386,478
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-10-31No
Was there a failure to transmit to the plan any participant contributions2016-10-31No
Has the plan failed to provide any benefit when due under the plan2016-10-31No
Contributions received in cash from employer2016-10-31$824,347
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-10-31$828,001
Did the plan have assets held for investment2016-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-10-31No
Opinion of an independent qualified public accountant for this plan2016-10-31Unqualified
Accountancy firm name2016-10-31BLUE & CO, LLC
Accountancy firm EIN2016-10-31351178661
2015 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-10-31$0
Total income from all sources (including contributions)2015-10-31$2,356,290
Total loss/gain on sale of assets2015-10-31$0
Total of all expenses incurred2015-10-31$2,356,290
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-10-31$2,158,263
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-10-31$2,356,290
Value of total assets at end of year2015-10-31$0
Value of total assets at beginning of year2015-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-10-31$198,027
Total interest from all sources2015-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-10-31No
Was this plan covered by a fidelity bond2015-10-31Yes
Value of fidelity bond cover2015-10-31$4,000,000
Were there any nonexempt tranactions with any party-in-interest2015-10-31No
Contributions received from participants2015-10-31$550,462
Administrative expenses (other) incurred2015-10-31$198,027
Total non interest bearing cash at end of year2015-10-31$0
Total non interest bearing cash at beginning of year2015-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-10-31No
Value of net income/loss2015-10-31$0
Value of net assets at end of year (total assets less liabilities)2015-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2015-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-10-31No
Were any leases to which the plan was party in default or uncollectible2015-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-10-31$314,776
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-10-31No
Was there a failure to transmit to the plan any participant contributions2015-10-31No
Has the plan failed to provide any benefit when due under the plan2015-10-31No
Contributions received in cash from employer2015-10-31$1,805,828
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-10-31$1,843,487
Did the plan have assets held for investment2015-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-10-31No
Opinion of an independent qualified public accountant for this plan2015-10-31Unqualified
Accountancy firm name2015-10-31BLUE & CO, LLC
Accountancy firm EIN2015-10-31351178661
2014 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2014 401k financial data
Total income from all sources (including contributions)2014-10-31$2,096,715
Total of all expenses incurred2014-10-31$2,096,715
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-10-31$1,919,117
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-10-31$2,096,715
Value of total assets at end of year2014-10-31$0
Value of total assets at beginning of year2014-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-10-31$177,598
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-10-31No
Was this plan covered by a fidelity bond2014-10-31Yes
Value of fidelity bond cover2014-10-31$4,000,000
Were there any nonexempt tranactions with any party-in-interest2014-10-31No
Contributions received from participants2014-10-31$535,916
Administrative expenses (other) incurred2014-10-31$177,598
Total non interest bearing cash at end of year2014-10-31$0
Total non interest bearing cash at beginning of year2014-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-10-31No
Value of net income/loss2014-10-31$0
Value of net assets at end of year (total assets less liabilities)2014-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2014-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-10-31No
Were any leases to which the plan was party in default or uncollectible2014-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2014-10-31$311,920
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-10-31No
Was there a failure to transmit to the plan any participant contributions2014-10-31No
Has the plan failed to provide any benefit when due under the plan2014-10-31No
Assets. Invements in employer securities at beginning of year2014-10-31$0
Contributions received in cash from employer2014-10-31$1,560,799
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-10-31$1,607,197
Did the plan have assets held for investment2014-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-10-31No
Opinion of an independent qualified public accountant for this plan2014-10-31Unqualified
Accountancy firm name2014-10-31BLUE & CO, LLC
Accountancy firm EIN2014-10-31351178661
2013 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2013 401k financial data
Total income from all sources (including contributions)2013-10-31$1,789,769
Total of all expenses incurred2013-10-31$1,789,769
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-10-31$1,664,288
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-10-31$1,789,769
Value of total assets at end of year2013-10-31$0
Value of total assets at beginning of year2013-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-10-31$125,481
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-10-31No
Was this plan covered by a fidelity bond2013-10-31Yes
Value of fidelity bond cover2013-10-31$4,000,000
Were there any nonexempt tranactions with any party-in-interest2013-10-31No
Contributions received from participants2013-10-31$426,244
Administrative expenses (other) incurred2013-10-31$125,481
Total non interest bearing cash at end of year2013-10-31$0
Total non interest bearing cash at beginning of year2013-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-10-31No
Value of net income/loss2013-10-31$0
Value of net assets at end of year (total assets less liabilities)2013-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-10-31No
Were any leases to which the plan was party in default or uncollectible2013-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-10-31$261,503
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-10-31No
Was there a failure to transmit to the plan any participant contributions2013-10-31No
Has the plan failed to provide any benefit when due under the plan2013-10-31No
Assets. Invements in employer securities at end of year2013-10-31$0
Assets. Invements in employer securities at beginning of year2013-10-31$0
Contributions received in cash from employer2013-10-31$1,363,525
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-10-31$1,402,785
Did the plan have assets held for investment2013-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-10-31No
Opinion of an independent qualified public accountant for this plan2013-10-31Unqualified
Accountancy firm name2013-10-31BLUE & CO, LLC
Accountancy firm EIN2013-10-31351178661
2012 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2012 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-10-31$0
Total income from all sources (including contributions)2012-10-31$1,549,206
Total of all expenses incurred2012-10-31$1,549,206
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-10-31$1,456,792
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-10-31$1,549,206
Value of total assets at end of year2012-10-31$0
Value of total assets at beginning of year2012-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-10-31$92,414
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-10-31No
Was this plan covered by a fidelity bond2012-10-31Yes
Value of fidelity bond cover2012-10-31$4,000,000
Were there any nonexempt tranactions with any party-in-interest2012-10-31No
Contributions received from participants2012-10-31$387,745
Administrative expenses (other) incurred2012-10-31$92,414
Total non interest bearing cash at end of year2012-10-31$0
Total non interest bearing cash at beginning of year2012-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-10-31No
Value of net income/loss2012-10-31$0
Value of net assets at end of year (total assets less liabilities)2012-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2012-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-10-31No
Were any leases to which the plan was party in default or uncollectible2012-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2012-10-31$230,153
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-10-31No
Was there a failure to transmit to the plan any participant contributions2012-10-31No
Has the plan failed to provide any benefit when due under the plan2012-10-31No
Assets. Invements in employer securities at end of year2012-10-31$0
Contributions received in cash from employer2012-10-31$1,161,461
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-10-31$1,226,639
Did the plan have assets held for investment2012-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-10-31No
Opinion of an independent qualified public accountant for this plan2012-10-31Unqualified
Accountancy firm name2012-10-31BLUE & CO, LLC
Accountancy firm EIN2012-10-31351178661
2011 : FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-10-31$0
Total income from all sources (including contributions)2011-10-31$1,650,028
Total loss/gain on sale of assets2011-10-31$0
Total of all expenses incurred2011-10-31$1,650,028
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-10-31$1,556,980
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-10-31$1,650,028
Value of total assets at end of year2011-10-31$0
Value of total assets at beginning of year2011-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-10-31$93,048
Total interest from all sources2011-10-31$0
Total dividends received (eg from common stock, registered investment company shares)2011-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-10-31No
Was this plan covered by a fidelity bond2011-10-31Yes
Value of fidelity bond cover2011-10-31$4,000,000
Were there any nonexempt tranactions with any party-in-interest2011-10-31No
Contributions received from participants2011-10-31$372,154
Total non interest bearing cash at end of year2011-10-31$0
Total non interest bearing cash at beginning of year2011-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-10-31No
Value of net income/loss2011-10-31$0
Value of net assets at end of year (total assets less liabilities)2011-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2011-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-10-31No
Were any leases to which the plan was party in default or uncollectible2011-10-31No
Expenses. Payments to insurance carriers foe the provision of benefits2011-10-31$199,716
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-10-31No
Was there a failure to transmit to the plan any participant contributions2011-10-31No
Has the plan failed to provide any benefit when due under the plan2011-10-31No
Contributions received in cash from employer2011-10-31$1,277,874
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-10-31$1,357,264
Contract administrator fees2011-10-31$93,048
Did the plan have assets held for investment2011-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-10-31No
Opinion of an independent qualified public accountant for this plan2011-10-31Unqualified
Accountancy firm name2011-10-31BLUE & CO, LLC
Accountancy firm EIN2011-10-31351178661

Form 5500 Responses for FOUR COUNTY EMPLOYEE HEALTH CARE PLAN

2021: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Submission has been amendedNo
2021-11-01This submission is the final filingNo
2021-11-01This return/report is a short plan year return/report (less than 12 months)No
2021-11-01Plan is a collectively bargained planNo
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – TrustYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement - TrustYes
2020: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Submission has been amendedNo
2020-11-01This submission is the final filingNo
2020-11-01This return/report is a short plan year return/report (less than 12 months)No
2020-11-01Plan is a collectively bargained planNo
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – TrustYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement - TrustYes
2019: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Submission has been amendedNo
2019-11-01This submission is the final filingNo
2019-11-01This return/report is a short plan year return/report (less than 12 months)No
2019-11-01Plan is a collectively bargained planNo
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – TrustYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement - TrustYes
2018: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Submission has been amendedNo
2018-11-01This submission is the final filingNo
2018-11-01This return/report is a short plan year return/report (less than 12 months)No
2018-11-01Plan is a collectively bargained planNo
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – TrustYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement - TrustYes
2017: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)No
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – TrustYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement - TrustYes
2016: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – TrustYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement - TrustYes
2015: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – TrustYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement - TrustYes
2014: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – TrustYes
2014-11-01Plan benefit arrangement – InsuranceYes
2014-11-01Plan benefit arrangement - TrustYes
2013: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan funding arrangement – TrustYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement - TrustYes
2012: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan funding arrangement – TrustYes
2012-11-01Plan benefit arrangement – InsuranceYes
2012-11-01Plan benefit arrangement - TrustYes
2011: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan funding arrangement – TrustYes
2011-11-01Plan benefit arrangement – InsuranceYes
2011-11-01Plan benefit arrangement - TrustYes
2010: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Submission has been amendedNo
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan funding arrangement – TrustYes
2010-11-01Plan benefit arrangement – InsuranceYes
2010-11-01Plan benefit arrangement - TrustYes
2009: FOUR COUNTY EMPLOYEE HEALTH CARE PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan funding arrangement – TrustYes
2009-11-01Plan benefit arrangement – InsuranceYes
2009-11-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12010817
Policy instance 2
Insurance contract or identification number12010817
Number of Individuals Covered198
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $26,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberF1066
Policy instance 1
Insurance contract or identification numberF1066
Number of Individuals Covered187
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRANSPLANT
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 CarrierUSD $720,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract numberF1066
Policy instance 1
Insurance contract or identification numberF1066
Number of Individuals Covered208
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRANSPLANT
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 CarrierUSD $541,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12010817
Policy instance 2
Insurance contract or identification number12010817
Number of Individuals Covered194
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $25,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract numberF1066
Policy instance 1
Insurance contract or identification numberF1066
Number of Individuals Covered185
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRANSPLANT
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 CarrierUSD $608,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12010817
Policy instance 2
Insurance contract or identification number12010817
Number of Individuals Covered186
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $28,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12010817
Policy instance 2
Insurance contract or identification number12010817
Number of Individuals Covered182
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $25,029
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 number417007411303
Policy instance 3
Insurance contract or identification number417007411303
Number of Individuals Covered187
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $386,251
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 number417006411303
Policy instance 1
Insurance contract or identification number417006411303
Number of Individuals Covered187
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRANSPLANT
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 CarrierUSD $15,810
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 number417006411303
Policy instance 1
Insurance contract or identification number417006411303
Number of Individuals Covered160
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRANSPLANT
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 CarrierUSD $16,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12010817
Policy instance 2
Insurance contract or identification number12010817
Number of Individuals Covered179
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $26,833
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 number417003411303
Policy instance 1
Insurance contract or identification number417003411303
Number of Individuals Covered162
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $273,464
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 number417004411303
Policy instance 2
Insurance contract or identification number417004411303
Number of Individuals Covered161
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRANSPLANT
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 CarrierUSD $17,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number12010817
Policy instance 3
Insurance contract or identification number12010817
Number of Individuals Covered158
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $23,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number12010817
Policy instance 3
Insurance contract or identification number12010817
Number of Individuals Covered167
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,865
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 number417003411303
Policy instance 1
Insurance contract or identification number417003411303
Number of Individuals Covered167
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $266,888
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 number417004411303
Policy instance 2
Insurance contract or identification number417004411303
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $21,167
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 number417003411303
Policy instance 1
Insurance contract or identification number417003411303
Number of Individuals Covered169
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $224,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number12010817
Policy instance 3
Insurance contract or identification number12010817
Number of Individuals Covered155
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,959
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 number417004411303
Policy instance 2
Insurance contract or identification number417004411303
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $19,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract numberUS060616
Policy instance 3
Insurance contract or identification numberUS060616
Number of Individuals Covered144
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $1,311
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedORGAN DONOR TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $13,109
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
Policy instance 1
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $193,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number12010817
Policy instance 2
Insurance contract or identification number12010817
Number of Individuals Covered158
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract numberUS041390
Policy instance 3
Insurance contract or identification numberUS041390
Number of Individuals Covered154
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedORGAN DONOR TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $16,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number12010817
Policy instance 2
Insurance contract or identification number12010817
Number of Individuals Covered146
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number40-19-144
Policy instance 1
Insurance contract or identification number40-19-144
Number of Individuals Covered164
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $164,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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