401k Plan data: ELICA HEALTH CENTERS 403(B) PLAN plan

ELICA HEALTH CENTERS 403(B) PLAN 401k Plan overview

Plan Name	ELICA HEALTH CENTERS 403(B) PLAN
Plan identification number	001

ELICA HEALTH CENTERS 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ELICA HEALTH CENTERS has sponsored the creation of one or more 401k plans.

Company Name: ELICA HEALTH CENTERS

Employer identification number (EIN): 371424390

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Additional information about ELICA HEALTH CENTERS

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C2379481

More information about ELICA HEALTH CENTERS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ELICA HEALTH CENTERS 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JAMES MOHRHERR 2023-08-18
001 2021-01-01 JAMES MOHRHERR 2022-10-11
001 2020-01-01 JAMES MOHRHERS 2021-08-24 JAMES MOHRHERS 2021-08-24
001 2019-01-01 JAMES MOHRHERS 2020-10-08 JAMES MOHRHERS 2020-10-08
001 2018-01-01 JAMES MOHRHERS 2019-09-09 JAMES MOHRHERS 2019-09-09
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	JAMES MOHRHERR	2023-08-18
001	2021-01-01	JAMES MOHRHERR	2022-10-11
001	2020-01-01	JAMES MOHRHERS	2021-08-24	JAMES MOHRHERS	2021-08-24
001	2019-01-01	JAMES MOHRHERS	2020-10-08	JAMES MOHRHERS	2020-10-08
001	2018-01-01	JAMES MOHRHERS	2019-09-09	JAMES MOHRHERS	2019-09-09
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01

Plan Statistics for ELICA HEALTH CENTERS 403(B) PLAN

401k plan membership statisitcs for ELICA HEALTH CENTERS 403(B) PLAN

Measure Date Value
2022: ELICA HEALTH CENTERS 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 518
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 539
Number of retired or separated participants receiving benefits 2022-01-01 4
Number of other retired or separated participants entitled to future benefits 2022-01-01 72
Total of all active and inactive participants 2022-01-01 615
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 615
Number of participants with account balances 2022-01-01 304
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: ELICA HEALTH CENTERS 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 464
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 473
Number of retired or separated participants receiving benefits 2021-01-01 7
Number of other retired or separated participants entitled to future benefits 2021-01-01 35
Total of all active and inactive participants 2021-01-01 515
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 515
Number of participants with account balances 2021-01-01 231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: ELICA HEALTH CENTERS 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 348
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 435
Number of other retired or separated participants entitled to future benefits 2020-01-01 26
Total of all active and inactive participants 2020-01-01 461
Total participants 2020-01-01 461
Number of participants with account balances 2020-01-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 1
2019: ELICA HEALTH CENTERS 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 302
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 331
Number of retired or separated participants receiving benefits 2019-01-01 7
Number of other retired or separated participants entitled to future benefits 2019-01-01 7
Total of all active and inactive participants 2019-01-01 345
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 345
Number of participants with account balances 2019-01-01 95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 1
2018: ELICA HEALTH CENTERS 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 223
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 276
Number of retired or separated participants receiving benefits 2018-01-01 9
Number of other retired or separated participants entitled to future benefits 2018-01-01 7
Total of all active and inactive participants 2018-01-01 292
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 292
Number of participants with account balances 2018-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 4
2017: ELICA HEALTH CENTERS 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 209
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 216
Number of participants with account balances 2017-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 3
2016: ELICA HEALTH CENTERS 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 189
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 3
Total of all active and inactive participants 2016-01-01 192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 192
Number of participants with account balances 2016-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2

Measure	Date	Value
2022: ELICA HEALTH CENTERS 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	518
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	539
Number of retired or separated participants receiving benefits	2022-01-01	4
Number of other retired or separated participants entitled to future benefits	2022-01-01	72
Total of all active and inactive participants	2022-01-01	615
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	615
Number of participants with account balances	2022-01-01	304
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: ELICA HEALTH CENTERS 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	464
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	473
Number of retired or separated participants receiving benefits	2021-01-01	7
Number of other retired or separated participants entitled to future benefits	2021-01-01	35
Total of all active and inactive participants	2021-01-01	515
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	515
Number of participants with account balances	2021-01-01	231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: ELICA HEALTH CENTERS 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	348
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	435
Number of other retired or separated participants entitled to future benefits	2020-01-01	26
Total of all active and inactive participants	2020-01-01	461
Total participants	2020-01-01	461
Number of participants with account balances	2020-01-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	1
2019: ELICA HEALTH CENTERS 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	302
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	331
Number of retired or separated participants receiving benefits	2019-01-01	7
Number of other retired or separated participants entitled to future benefits	2019-01-01	7
Total of all active and inactive participants	2019-01-01	345
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	345
Number of participants with account balances	2019-01-01	95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	1
2018: ELICA HEALTH CENTERS 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	223
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	276
Number of retired or separated participants receiving benefits	2018-01-01	9
Number of other retired or separated participants entitled to future benefits	2018-01-01	7
Total of all active and inactive participants	2018-01-01	292
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	292
Number of participants with account balances	2018-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	4
2017: ELICA HEALTH CENTERS 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	209
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	216
Number of participants with account balances	2017-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	3
2016: ELICA HEALTH CENTERS 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	189
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	3
Total of all active and inactive participants	2016-01-01	192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	192
Number of participants with account balances	2016-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2

Financial Data on ELICA HEALTH CENTERS 403(B) PLAN

Measure	Date	Value
2022 : ELICA HEALTH CENTERS 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$1,346,591
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$497,612
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$470,921
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,056,013
Value of total assets at end of year	2022-12-31	$4,660,737
Value of total assets at beginning of year	2022-12-31	$3,811,758
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$26,691
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$619
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$619
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$1,375,177
Participant contributions at end of year	2022-12-31	$51,144
Participant contributions at beginning of year	2022-12-31	$64,763
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$86,393
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$848,979
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,660,737
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,811,758
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$4,552,135
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$3,699,928
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$30,626
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$24,756
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-710,041
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$594,443
Employer contributions (assets) at end of year	2022-12-31	$26,832
Employer contributions (assets) at beginning of year	2022-12-31	$22,311
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$470,921
Contract administrator fees	2022-12-31	$26,691
Did the plan have assets held for investment	2022-12-31	Yes
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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MANN, URRUTIA, NELSON, CPAS & ASSOC
Accountancy firm EIN	2022-12-31	200276349
2021 : ELICA HEALTH CENTERS 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,943,999
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$249,956
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$239,113
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,532,903
Value of total assets at end of year	2021-12-31	$3,811,758
Value of total assets at beginning of year	2021-12-31	$2,117,715
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$10,843
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$27
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$27
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$988,892
Participant contributions at end of year	2021-12-31	$64,763
Participant contributions at beginning of year	2021-12-31	$26,743
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$98,621
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$1,694,043
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,811,758
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,117,715
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$10,843
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$3,699,928
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,050,415
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$24,756
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$40,557
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$411,069
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$445,390
Employer contributions (assets) at end of year	2021-12-31	$22,311
Employer contributions (assets) at beginning of year	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$239,113
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	Yes
Did the plan have assets held for investment	2021-12-31	Yes
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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MANN, URRUTIA, NELSON, CPAS & ASSOC
Accountancy firm EIN	2021-12-31	200276349
2020 : ELICA HEALTH CENTERS 403(B) PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$1,008,608
Total of all expenses incurred	2020-12-31	$337,028
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$333,917
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$734,829
Value of total assets at end of year	2020-12-31	$2,117,715
Value of total assets at beginning of year	2020-12-31	$1,446,135
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$3,111
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$663,063
Participant contributions at end of year	2020-12-31	$26,743
Participant contributions at beginning of year	2020-12-31	$26,420
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$71,766
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$671,580
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,117,715
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,446,135
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,050,415
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,407,705
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$40,557
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$8,880
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$273,779
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Employer contributions (assets) at beginning of year	2020-12-31	$3,130
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$333,917
Contract administrator fees	2020-12-31	$3,111
Did the plan have assets held for investment	2020-12-31	Yes
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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MANN, URRUTIA, NELSON, CPAS & ASSOC
Accountancy firm EIN	2020-12-31	200276349
2019 : ELICA HEALTH CENTERS 403(B) PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$802,566
Total of all expenses incurred	2019-12-31	$161,998
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$159,848
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$600,885
Value of total assets at end of year	2019-12-31	$1,446,135
Value of total assets at beginning of year	2019-12-31	$805,567
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,150
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$580,276
Participant contributions at beginning of year	2019-12-31	$0
Participant contributions at end of year	2019-12-31	$26,420
Participant contributions at beginning of year	2019-12-31	$17,652
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$17,479
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$640,568
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,446,135
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$805,567
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,407,705
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$780,054
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$8,880
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$7,861
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$201,681
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$3,130
Employer contributions (assets) at end of year	2019-12-31	$3,130
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$159,848
Contract administrator fees	2019-12-31	$2,150
Did the plan have assets held for investment	2019-12-31	Yes
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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MANN, URRUTIA, NELSON, CPAS & ASSOC
Accountancy firm EIN	2019-12-31	200276349
2018 : ELICA HEALTH CENTERS 403(B) PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$374,626
Total of all expenses incurred	2018-12-31	$400,968
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$399,203
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$436,841
Value of total assets at end of year	2018-12-31	$805,567
Value of total assets at beginning of year	2018-12-31	$831,909
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,765
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$402,839
Participant contributions at end of year	2018-12-31	$0
Participant contributions at end of year	2018-12-31	$17,652
Participant contributions at beginning of year	2018-12-31	$18,753
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$34,002
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$0
Total non interest bearing cash at end of year	2018-12-31	$0
Total non interest bearing cash at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Income. Non cash contributions	2018-12-31	$0
Value of net income/loss	2018-12-31	$-26,342
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$805,567
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$831,909
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$780,054
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$774,412
Interest earned on other investments	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$7,861
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$5,008
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-62,215
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$33,736
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$399,203
Contract administrator fees	2018-12-31	$1,765
Did the plan have assets held for investment	2018-12-31	Yes
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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	MANN, URRUTIA, NELSON, CPAS & ASSOC
Accountancy firm EIN	2018-12-31	200276349
2017 : ELICA HEALTH CENTERS 403(B) PLAN 2017 401k financial data
Total transfer of assets to this plan	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$353,711
Total of all expenses incurred	2017-12-31	$51,333
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$49,903
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$262,728
Value of total assets at end of year	2017-12-31	$831,909
Value of total assets at beginning of year	2017-12-31	$529,531
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,430
Total interest from all sources	2017-12-31	$43
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$12,031
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$12,031
Administrative expenses professional fees incurred	2017-12-31	$0
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$45,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$228,845
Participant contributions at end of year	2017-12-31	$18,753
Participant contributions at beginning of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$147
Administrative expenses (other) incurred	2017-12-31	$315
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$302,378
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$831,909
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$529,531
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$774,412
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$511,096
Interest earned on other investments	2017-12-31	$43
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$5,008
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$2,895
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$78,909
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$33,736
Employer contributions (assets) at end of year	2017-12-31	$33,736
Employer contributions (assets) at beginning of year	2017-12-31	$15,540
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$49,903
Contract administrator fees	2017-12-31	$1,115
Did the plan have assets held for investment	2017-12-31	Yes
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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	MANN, URRUTIA, NELSON, CPAS & ASSOC
Accountancy firm EIN	2017-12-31	200276349
2016 : ELICA HEALTH CENTERS 403(B) PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$228,097
Total of all expenses incurred	2016-12-31	$26,701
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$26,206
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$203,555
Value of total assets at end of year	2016-12-31	$529,531
Value of total assets at beginning of year	2016-12-31	$328,135
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$495
Total interest from all sources	2016-12-31	$7
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$4,961
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$4,961
Was this plan covered by a fidelity bond	2016-12-31	No
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$170,479
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$23,796
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$201,396
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$529,531
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$328,135
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$511,096
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$312,555
Interest earned on other investments	2016-12-31	$7
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$2,895
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$19,574
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$9,280
Employer contributions (assets) at end of year	2016-12-31	$15,540
Employer contributions (assets) at beginning of year	2016-12-31	$15,580
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$26,206
Contract administrator fees	2016-12-31	$495
Did the plan have assets held for investment	2016-12-31	Yes
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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	MANN, URRUTIA, NELSON, CPAS & ASSOC
Accountancy firm EIN	2016-12-31	200276349

Form 5500 Responses for ELICA HEALTH CENTERS 403(B) PLAN

2022: ELICA HEALTH CENTERS 403(B) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: ELICA HEALTH CENTERS 403(B) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: ELICA HEALTH CENTERS 403(B) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: ELICA HEALTH CENTERS 403(B) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: ELICA HEALTH CENTERS 403(B) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: ELICA HEALTH CENTERS 403(B) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: ELICA HEALTH CENTERS 403(B) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

470631

Policy instance

Insurance contract or identification number	470631
Number of Individuals Covered	304
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $69
Total amount of fees paid to insurance company	USD $5
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53
Insurance broker organization code?	3
Amount paid for insurance broker fees	5
Additional information about fees paid to insurance broker	REFERRAL/ SERVICE FEE

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

470631

Policy instance

Insurance contract or identification number	470631
Number of Individuals Covered	225
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	469
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $132
Total amount of fees paid to insurance company	USD $15
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $132
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	REFERRRAL/SERVICE FEE

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	356
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $52
Total amount of fees paid to insurance company	USD $4
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52
Insurance broker organization code?	3
Amount paid for insurance broker fees	4
Additional information about fees paid to insurance broker	REFERRAL/ SERVICE FEE

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	225
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $16
Total amount of fees paid to insurance company	USD $2
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $16
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	RFERRAL/SERVICE FEE
Insurance broker name	FARMER & BETTS, INC.

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Company Name:	ELICA HEALTH CENTERS
Employer identification number (EIN):	371424390
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C2379481