401k Plan data: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN plan

RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN
Plan identification number	510

RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

RIVERVALLEY CONSULTING SERVICES has sponsored the creation of one or more 401k plans.

Company Name: RIVERVALLEY CONSULTING SERVICES

Employer identification number (EIN): 611354311

NAIC Classification: 621420
NAIC Description: Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2022-07-01 GRANT MILLER 2024-03-04
510 2021-07-01 CATHRYN H GADDIS 2023-01-17
510 2020-07-01 CATHRYN H GADDIS 2022-03-22
510 2019-07-01 CATHRYN H GADDIS 2020-12-29
510 2018-07-01 CATHRYN H GADDIS 2020-01-30
510 2017-07-01
510 2016-07-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
510	2022-07-01	GRANT MILLER	2024-03-04
510	2021-07-01	CATHRYN H GADDIS	2023-01-17
510	2020-07-01	CATHRYN H GADDIS	2022-03-22
510	2019-07-01	CATHRYN H GADDIS	2020-12-29
510	2018-07-01	CATHRYN H GADDIS	2020-01-30
510	2017-07-01
510	2016-07-01

Plan Statistics for RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN

401k plan membership statisitcs for RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN

Measure Date Value
2022: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 339
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 393
Total of all active and inactive participants 2022-07-01 393
2021: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 412
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 339
Total of all active and inactive participants 2021-07-01 339
2020: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 392
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 412
Total of all active and inactive participants 2020-07-01 412
2019: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 432
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 392
Total of all active and inactive participants 2019-07-01 392
2018: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 415
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 432
Total of all active and inactive participants 2018-07-01 432
2017: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 402
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 415
Total of all active and inactive participants 2017-07-01 415
Total participants 2017-07-01 415
2016: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 435
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 399
Number of retired or separated participants receiving benefits 2016-07-01 3
Total of all active and inactive participants 2016-07-01 402
Total participants 2016-07-01 402

Measure	Date	Value
2022: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	339
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	393
Total of all active and inactive participants	2022-07-01	393
2021: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	412
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	339
Total of all active and inactive participants	2021-07-01	339
2020: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	392
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	412
Total of all active and inactive participants	2020-07-01	412
2019: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	432
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	392
Total of all active and inactive participants	2019-07-01	392
2018: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	415
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	432
Total of all active and inactive participants	2018-07-01	432
2017: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	402
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	415
Total of all active and inactive participants	2017-07-01	415
Total participants	2017-07-01	415
2016: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	435
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	399
Number of retired or separated participants receiving benefits	2016-07-01	3
Total of all active and inactive participants	2016-07-01	402
Total participants	2016-07-01	402

Form 5500 Responses for RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN

2022: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: RIVERVALLEY CONSULTING SERVICES WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	First time form 5500 has been submitted	Yes
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200681

Policy instance

Insurance contract or identification number	0200681
Number of Individuals Covered	96
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,000
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $15,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,000
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200682

Policy instance

Insurance contract or identification number	0200682
Number of Individuals Covered	150
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,061
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $10,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,061
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00617134

Policy instance

Insurance contract or identification number	G 00617134
Number of Individuals Covered	393
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $13,418
Total amount of fees paid to insurance company	USD $5,649
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $134,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,418
Amount paid for insurance broker fees	5649
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00512673

Policy instance

Insurance contract or identification number	00512673
Number of Individuals Covered	206
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,610
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,610
Insurance broker organization code?	3

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 )

Policy contract number

806335323531

Policy instance

Insurance contract or identification number	806335323531
Number of Individuals Covered	397
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $6,269
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $125,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,269
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W26153

Policy instance

Insurance contract or identification number	W26153
Number of Individuals Covered	275
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Welfare Benefit Premiums Paid to Carrier	USD $321,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W26153

Policy instance

Insurance contract or identification number	W26153
Number of Individuals Covered	272
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Welfare Benefit Premiums Paid to Carrier	USD $308,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00512673

Policy instance

Insurance contract or identification number	00512673
Number of Individuals Covered	196
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,641
Total amount of fees paid to insurance company	USD $1,201
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,641
Amount paid for insurance broker fees	1201
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00617134

Policy instance

Insurance contract or identification number	G 00617134
Number of Individuals Covered	339
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $12,538
Total amount of fees paid to insurance company	USD $3,294
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $150,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,538
Amount paid for insurance broker fees	3294
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200682

Policy instance

Insurance contract or identification number	0200682
Number of Individuals Covered	150
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,209
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $11,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,209
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200681

Policy instance

Insurance contract or identification number	0200681
Number of Individuals Covered	85
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $2,240
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $17,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,240
Insurance broker organization code?	3

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 )

Policy contract number

806335323531

Policy instance

Insurance contract or identification number	806335323531
Number of Individuals Covered	407
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $6,322
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,322
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W26153

Policy instance

Insurance contract or identification number	W26153
Number of Individuals Covered	329
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Welfare Benefit Premiums Paid to Carrier	USD $310,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00512673

Policy instance

Insurance contract or identification number	00512673
Number of Individuals Covered	226
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $1,830
Total amount of fees paid to insurance company	USD $1,168
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,830
Amount paid for insurance broker fees	1168
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00617134

Policy instance

Insurance contract or identification number	G 00617134
Number of Individuals Covered	474
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $10,648
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE, VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $142,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,648
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200682

Policy instance

Insurance contract or identification number	0200682
Number of Individuals Covered	174
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,786
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $13,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,786
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200681

Policy instance

Insurance contract or identification number	0200681
Number of Individuals Covered	53
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,358
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $17,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,358
Insurance broker organization code?	3

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 )

Policy contract number

806335323531

Policy instance

Insurance contract or identification number	806335323531
Number of Individuals Covered	407
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $6,322
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,322
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200681

Policy instance

Insurance contract or identification number	0200681
Number of Individuals Covered	79
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $3,467
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $17,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,467
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200682

Policy instance

Insurance contract or identification number	0200682
Number of Individuals Covered	174
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $3,232
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $14,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,232
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00617134

Policy instance

Insurance contract or identification number	G 00617134
Number of Individuals Covered	392
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $11,399
Total amount of fees paid to insurance company	USD $2,276
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE, VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $145,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,399
Amount paid for insurance broker fees	2276
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 )

Policy contract number

806335323531

Policy instance

Insurance contract or identification number	806335323531
Number of Individuals Covered	385
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $6,317
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,317
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W26153

Policy instance

Insurance contract or identification number	W26153
Number of Individuals Covered	310
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Welfare Benefit Premiums Paid to Carrier	USD $240,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00512673

Policy instance

Insurance contract or identification number	00512673
Number of Individuals Covered	222
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $1,833
Total amount of fees paid to insurance company	USD $1,548
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,833
Amount paid for insurance broker fees	1548
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200681

Policy instance

Insurance contract or identification number	0200681
Number of Individuals Covered	62
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $8,491
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $20,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,491
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00246226

Policy instance

Insurance contract or identification number	00246226
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Welfare Benefit Premiums Paid to Carrier	USD $-528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 )

Policy contract number

806335323531

Policy instance

Insurance contract or identification number	806335323531
Number of Individuals Covered	416
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $7,015
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,015
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00512673

Policy instance

Insurance contract or identification number	00512673
Number of Individuals Covered	249
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $1,672
Total amount of fees paid to insurance company	USD $1,612
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,672
Amount paid for insurance broker fees	1612
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00617134

Policy instance

Insurance contract or identification number	G 00617134
Number of Individuals Covered	432
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $12,955
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE/AD&D
Welfare Benefit Premiums Paid to Carrier	USD $160,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,955
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200682

Policy instance

Insurance contract or identification number	0200682
Number of Individuals Covered	207
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $6,399
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $15,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,399
Insurance broker organization code?	3

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96687 )

Policy contract number

806335323531

Policy instance

Insurance contract or identification number	806335323531
Number of Individuals Covered	420
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $7,341
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $146,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00512673

Policy instance

Insurance contract or identification number	00512673
Number of Individuals Covered	237
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,982
Total amount of fees paid to insurance company	USD $1,197
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX964809

Policy instance

Insurance contract or identification number	FLX964809
Number of Individuals Covered	415
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of fees paid to insurance company	USD $2,606
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 966416

Policy instance

Insurance contract or identification number	OK 966416
Number of Individuals Covered	415
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of fees paid to insurance company	USD $398
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $-18,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT961884

Policy instance

Insurance contract or identification number	VDT961884
Number of Individuals Covered	68
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $4,448
Total amount of fees paid to insurance company	USD $1,277
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 963360

Policy instance

Insurance contract or identification number	LK 963360
Number of Individuals Covered	349
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of fees paid to insurance company	USD $1,947
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

21651

Policy instance

Insurance contract or identification number	21651
Number of Individuals Covered	70
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $4,223
Other welfare benefits provided	ACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $15,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200681

Policy instance

Insurance contract or identification number	0200681
Number of Individuals Covered	85
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $7,079
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $10,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0200682

Policy instance

Insurance contract or identification number	0200682
Number of Individuals Covered	111
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $4,552
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $7,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00246226

Policy instance

Insurance contract or identification number	00246226
Number of Individuals Covered	318
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Welfare Benefit Premiums Paid to Carrier	USD $233,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	RIVERVALLEY CONSULTING SERVICES
Employer identification number (EIN):	611354311
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers