401k Plan data: CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN plan

CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN 401k Plan overview

Plan Name	CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN
Plan identification number	501

CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES has sponsored the creation of one or more 401k plans.

Company Name: CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES

Employer identification number (EIN): 453532127

NAIC Classification: 611000

Additional information about CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES

Jurisdiction of Incorporation: California Department of State

Incorporation Date: 2011-09-29

Company Identification Number: C3413202

Legal Registered Office Address: 435 Alandele Avenue

Los Angeles
United States of America (USA)
90036

More information about CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-07-01

Plan Statistics for CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN

401k plan membership statisitcs for CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN

Measure Date Value
2017: CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 114
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 0
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 0
Total of all active and inactive participants 2017-07-01 0

Measure	Date	Value
2017: CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	114
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	0
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	0

Form 5500 Responses for CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN

2017: CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES MEDICAL, DENTAL AND VISION PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	First time form 5500 has been submitted	Yes
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	Yes
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

43435

Policy instance

Insurance contract or identification number	43435
Number of Individuals Covered	130
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $65,577
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $937,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

CITIZENS

Policy instance

Insurance contract or identification number	CITIZENS
Number of Individuals Covered	130
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30007487

Policy instance

Insurance contract or identification number	30007487
Number of Individuals Covered	130
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

Potentially related plans

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Company Name:	CITIZENS OF THE WORLD CHARTER SCHOOLS - LOS ANGELES
Employer identification number (EIN):	453532127
NAIC Classification:	611000

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	2011-09-29
Company Identification Number:	C3413202
Legal Registered Office Address:	435 Alandele Avenue Los Angeles United States of America (USA) 90036