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COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 401k Plan overview

Plan NameCOMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN
Plan identification number 510

COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

COMMUNITY LIVING OPTIONS has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY LIVING OPTIONS
Employer identification number (EIN):382433400
NAIC Classification:624200

Additional information about COMMUNITY LIVING OPTIONS

Jurisdiction of Incorporation: Michigan Secretary of State
Incorporation Date: 0000-00-00
Company Identification Number: 702367
Legal Registered Office Address: 626 REED AVE KALAMAZOO


United States of America (USA)
49001

More information about COMMUNITY LIVING OPTIONS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102018-11-01KAREN BURPEE2020-02-05
5102017-11-01
5102016-11-01
5102015-11-01KAREN BURPEE
5102013-11-01KAREN BURPEE
5102012-11-01KAREN BURPEE
5102011-11-01KAREN BURPEE

Plan Statistics for COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN

401k plan membership statisitcs for COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN

Measure Date Value
2018: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01105
Total number of active participants reported on line 7a of the Form 55002018-11-0195
Number of retired or separated participants receiving benefits2018-11-013
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-0198
Number of employers contributing to the scheme2018-11-010
2017: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01105
Total number of active participants reported on line 7a of the Form 55002017-11-01102
Number of retired or separated participants receiving benefits2017-11-012
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-01104
Number of employers contributing to the scheme2017-11-010
2016: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01110
Total number of active participants reported on line 7a of the Form 55002016-11-01105
Number of retired or separated participants receiving benefits2016-11-011
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01106
2015: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01101
Total number of active participants reported on line 7a of the Form 55002015-11-01110
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 participants2015-11-01110
2013: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01105
Total number of active participants reported on line 7a of the Form 55002013-11-0198
Number of retired or separated participants receiving benefits2013-11-010
Number of other retired or separated participants entitled to future benefits2013-11-010
Total of all active and inactive participants2013-11-0198
2012: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-01104
Total number of active participants reported on line 7a of the Form 55002012-11-01105
Number of retired or separated participants receiving benefits2012-11-010
Number of other retired or separated participants entitled to future benefits2012-11-010
Total of all active and inactive participants2012-11-01105
2011: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-01100
Total number of active participants reported on line 7a of the Form 55002011-11-01104
Number of retired or separated participants receiving benefits2011-11-010
Number of other retired or separated participants entitled to future benefits2011-11-010
Total of all active and inactive participants2011-11-01104

Form 5500 Responses for COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN

2018: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – General assets of the sponsorYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – General assets of the sponsorYes
2017: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – General assets of the sponsorYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – General assets of the sponsorYes
2016: COMMUNITY LIVING OPTIONS GROUP INSURANCE 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 – General assets of the sponsorYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – General assets of the sponsorYes
2015: COMMUNITY LIVING OPTIONS GROUP INSURANCE 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 – General assets of the sponsorYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – General assets of the sponsorYes
2013: COMMUNITY LIVING OPTIONS GROUP INSURANCE 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 – General assets of the sponsorYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – General assets of the sponsorYes
2012: COMMUNITY LIVING OPTIONS GROUP INSURANCE 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 – General assets of the sponsorYes
2012-11-01Plan benefit arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – General assets of the sponsorYes
2011: COMMUNITY LIVING OPTIONS GROUP INSURANCE PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01First time form 5500 has been submittedYes
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 – General assets of the sponsorYes
2011-11-01Plan benefit arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number792112
Policy instance 1
Insurance contract or identification number792112
Number of Individuals Covered96
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $21,448
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $536,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,448
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97988281001
Policy instance 2
Insurance contract or identification number97988281001
Number of Individuals Covered85
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $566
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $566
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number3726
Policy instance 3
Insurance contract or identification number3726
Number of Individuals Covered109
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $3,943
Total amount of fees paid to insurance companyUSD $222
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,943
Amount paid for insurance broker fees222
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0B84D
Policy instance 4
Insurance contract or identification numberGLUG0B84D
Number of Individuals Covered92
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $7,902
Total amount of fees paid to insurance companyUSD $3,147
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $52,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,902
Amount paid for insurance broker fees3147
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number792112
Policy instance 1
Insurance contract or identification number792112
Number of Individuals Covered103
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $19,543
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $478,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,543
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDAVID KOLENBRANDER
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9798828
Policy instance 2
Insurance contract or identification number9798828
Number of Individuals Covered93
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $599
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $599
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameOLIVIER VANDYK INSURANCE AGENCY
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number3726
Policy instance 3
Insurance contract or identification number3726
Number of Individuals Covered121
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $4,753
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,753
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameOLIVIER VANDYK INSURANCE AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0B84D
Policy instance 4
Insurance contract or identification numberGLUG0B84D
Number of Individuals Covered104
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $7,817
Total amount of fees paid to insurance companyUSD $217
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $52,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,817
Amount paid for insurance broker fees217
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameOLIVIER VANDYK INSURANCE AGENCY

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