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COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 401k Plan overview

Plan NameCOMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN
Plan identification number 501

COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT 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
  • Other welfare benefit cover

401k Sponsoring company profile

OUACHITA REGIONAL COUNSELING AND MENTAL HEALTH CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name:OUACHITA REGIONAL COUNSELING AND MENTAL HEALTH CENTER, INC.
Employer identification number (EIN):710401764
NAIC Classification:621420
NAIC Description:Outpatient Mental Health and Substance Abuse Centers

Additional information about OUACHITA REGIONAL COUNSELING AND MENTAL HEALTH CENTER, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1972-10-13
Company Identification Number: 430788
Legal Registered Office Address: 2458 STETZER RD.
-
BUCYRUS
United States of America (USA)
44820

More information about OUACHITA REGIONAL COUNSELING AND MENTAL HEALTH CENTER, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-02-01ROBERT GERSHON2023-07-24
5012021-02-01ROBERT GERSHON2022-07-19
5012020-02-01
5012019-02-01
5012018-02-01
5012017-02-01ROBERT GERSHON
5012016-02-01ROBERT GERSHON
5012015-02-01ROBERT GERSHON
5012014-02-01ROBERT GERSHON
5012013-02-01
5012012-02-01ROBERT GERSHON
5012011-02-01DR. DONALD MARTIN
5012010-02-01DR. DONALD MARTIN
5012009-02-01DONALD MARTIN

Plan Statistics for COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN

401k plan membership statisitcs for COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN

Measure Date Value
2022: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01113
Total number of active participants reported on line 7a of the Form 55002022-02-01114
Number of retired or separated participants receiving benefits2022-02-011
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01115
2021: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01108
Total number of active participants reported on line 7a of the Form 55002021-02-01124
Number of retired or separated participants receiving benefits2021-02-011
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01125
2020: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01165
Total number of active participants reported on line 7a of the Form 55002020-02-01162
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01162
2019: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01173
Total number of active participants reported on line 7a of the Form 55002019-02-01165
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01165
2018: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01155
Total number of active participants reported on line 7a of the Form 55002018-02-01173
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01173
2017: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-010
Total number of active participants reported on line 7a of the Form 55002017-02-01155
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01155
2016: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01164
Total number of active participants reported on line 7a of the Form 55002016-02-01142
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01142
2015: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01152
Total number of active participants reported on line 7a of the Form 55002015-02-01164
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01164
2014: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01128
Total number of active participants reported on line 7a of the Form 55002014-02-01152
Number of retired or separated participants receiving benefits2014-02-010
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-01152
2013: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01111
Total number of active participants reported on line 7a of the Form 55002013-02-01128
Total of all active and inactive participants2013-02-01128
2012: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01117
Total number of active participants reported on line 7a of the Form 55002012-02-01111
Total of all active and inactive participants2012-02-01111
2011: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01108
Total number of active participants reported on line 7a of the Form 55002011-02-01117
Total of all active and inactive participants2011-02-01117
2010: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-02-01120
Total number of active participants reported on line 7a of the Form 55002010-02-01108
Total of all active and inactive participants2010-02-01108
2009: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-01126
Total number of active participants reported on line 7a of the Form 55002009-02-01120
Total of all active and inactive participants2009-02-01120

Financial Data on COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN

Measure Date Value
2015 : COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-01-31$6,087
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-01-31$2,737
Total income from all sources (including contributions)2015-01-31$22,437
Total of all expenses incurred2015-01-31$75,886
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-01-31$69,940
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-01-31$22,252
Value of total assets at end of year2015-01-31$26,768
Value of total assets at beginning of year2015-01-31$76,867
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-01-31$5,946
Total interest from all sources2015-01-31$185
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-01-31No
Was this plan covered by a fidelity bond2015-01-31No
If this is an individual account plan, was there a blackout period2015-01-31No
Were there any nonexempt tranactions with any party-in-interest2015-01-31No
Contributions received from participants2015-01-31$16,878
Administrative expenses (other) incurred2015-01-31$5,946
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-01-31No
Value of net income/loss2015-01-31$-53,449
Value of net assets at end of year (total assets less liabilities)2015-01-31$20,681
Value of net assets at beginning of year (total assets less liabilities)2015-01-31$74,130
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-01-31No
Were any leases to which the plan was party in default or uncollectible2015-01-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-01-31$26,768
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-01-31$76,867
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-01-31$76,867
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-01-31$185
Expenses. Payments to insurance carriers foe the provision of benefits2015-01-31$69,940
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-01-31No
Was there a failure to transmit to the plan any participant contributions2015-01-31No
Has the plan failed to provide any benefit when due under the plan2015-01-31No
Contributions received in cash from employer2015-01-31$5,374
Liabilities. Value of benefit claims payable at end of year2015-01-31$6,087
Liabilities. Value of benefit claims payable at beginning of year2015-01-31$2,737
Did the plan have assets held for investment2015-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-01-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-01-31No
Opinion of an independent qualified public accountant for this plan2015-01-31Unqualified
Accountancy firm name2015-01-31JORDAN WOOSLEY CRONE & KEATON LTD
Accountancy firm EIN2015-01-31710401764
2014 : COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-01-31$2,737
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-01-31$24,310
Total income from all sources (including contributions)2014-01-31$102,926
Total of all expenses incurred2014-01-31$62,918
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-01-31$62,918
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-01-31$102,675
Value of total assets at end of year2014-01-31$76,867
Value of total assets at beginning of year2014-01-31$58,432
Total interest from all sources2014-01-31$251
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-01-31No
Was this plan covered by a fidelity bond2014-01-31No
If this is an individual account plan, was there a blackout period2014-01-31No
Were there any nonexempt tranactions with any party-in-interest2014-01-31No
Contributions received from participants2014-01-31$15,255
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-01-31No
Value of net income/loss2014-01-31$40,008
Value of net assets at end of year (total assets less liabilities)2014-01-31$74,130
Value of net assets at beginning of year (total assets less liabilities)2014-01-31$34,122
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-01-31No
Were any leases to which the plan was party in default or uncollectible2014-01-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-01-31$76,867
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-01-31$58,319
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-01-31$58,319
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-01-31$251
Expenses. Payments to insurance carriers foe the provision of benefits2014-01-31$5,149
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-01-31No
Was there a failure to transmit to the plan any participant contributions2014-01-31No
Has the plan failed to provide any benefit when due under the plan2014-01-31No
Contributions received in cash from employer2014-01-31$87,420
Employer contributions (assets) at beginning of year2014-01-31$113
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-01-31$57,769
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-01-31No
Liabilities. Value of benefit claims payable at end of year2014-01-31$2,737
Liabilities. Value of benefit claims payable at beginning of year2014-01-31$24,310
Did the plan have assets held for investment2014-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-01-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-01-31No
Opinion of an independent qualified public accountant for this plan2014-01-31Unqualified
Accountancy firm name2014-01-31JORDAN WOOSLEY CRONE & KEATON
Accountancy firm EIN2014-01-31710465329
2013 : COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-01-31$24,310
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-01-31$101,658
Total income from all sources (including contributions)2013-01-31$1,064,051
Total of all expenses incurred2013-01-31$1,029,929
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-01-31$985,981
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-01-31$1,052,612
Value of total assets at end of year2013-01-31$58,432
Value of total assets at beginning of year2013-01-31$101,658
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-01-31$43,948
Total interest from all sources2013-01-31$138
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-01-31No
Was this plan covered by a fidelity bond2013-01-31No
If this is an individual account plan, was there a blackout period2013-01-31No
Were there any nonexempt tranactions with any party-in-interest2013-01-31No
Contributions received from participants2013-01-31$173,543
Other income not declared elsewhere2013-01-31$11,301
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-01-31No
Value of net income/loss2013-01-31$34,122
Value of net assets at end of year (total assets less liabilities)2013-01-31$34,122
Value of net assets at beginning of year (total assets less liabilities)2013-01-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-01-31No
Were any leases to which the plan was party in default or uncollectible2013-01-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-01-31$58,319
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-01-31$1,686
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-01-31$1,686
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-01-31$138
Expenses. Payments to insurance carriers foe the provision of benefits2013-01-31$292,894
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-01-31No
Was there a failure to transmit to the plan any participant contributions2013-01-31No
Has the plan failed to provide any benefit when due under the plan2013-01-31No
Contributions received in cash from employer2013-01-31$879,069
Employer contributions (assets) at end of year2013-01-31$113
Employer contributions (assets) at beginning of year2013-01-31$99,972
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-01-31$693,087
Contract administrator fees2013-01-31$43,948
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-01-31No
Liabilities. Value of benefit claims payable at end of year2013-01-31$24,310
Liabilities. Value of benefit claims payable at beginning of year2013-01-31$101,658
Did the plan have assets held for investment2013-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-01-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-01-31No
Opinion of an independent qualified public accountant for this plan2013-01-31Unqualified
Accountancy firm name2013-01-31JORDAN WOOSLEY CRONE & KEATON LTD
Accountancy firm EIN2013-01-31710465329
2012 : COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-01-31$101,658
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-01-31$47,200
Total income from all sources (including contributions)2012-01-31$1,068,838
Total of all expenses incurred2012-01-31$1,068,838
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-01-31$1,031,494
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-01-31$959,271
Value of total assets at end of year2012-01-31$101,658
Value of total assets at beginning of year2012-01-31$47,200
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-01-31$37,344
Total interest from all sources2012-01-31$56
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-01-31No
Was this plan covered by a fidelity bond2012-01-31No
If this is an individual account plan, was there a blackout period2012-01-31No
Were there any nonexempt tranactions with any party-in-interest2012-01-31No
Contributions received from participants2012-01-31$135,271
Other income not declared elsewhere2012-01-31$109,511
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-01-31No
Value of net income/loss2012-01-31$0
Value of net assets at end of year (total assets less liabilities)2012-01-31$0
Value of net assets at beginning of year (total assets less liabilities)2012-01-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-01-31No
Were any leases to which the plan was party in default or uncollectible2012-01-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-01-31$1,686
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-01-31$1,506
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-01-31$1,506
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-01-31$56
Expenses. Payments to insurance carriers foe the provision of benefits2012-01-31$260,347
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-01-31No
Was there a failure to transmit to the plan any participant contributions2012-01-31No
Has the plan failed to provide any benefit when due under the plan2012-01-31No
Contributions received in cash from employer2012-01-31$824,000
Employer contributions (assets) at end of year2012-01-31$99,972
Employer contributions (assets) at beginning of year2012-01-31$45,694
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-01-31$771,147
Contract administrator fees2012-01-31$37,344
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-01-31No
Liabilities. Value of benefit claims payable at end of year2012-01-31$101,658
Liabilities. Value of benefit claims payable at beginning of year2012-01-31$47,200
Did the plan have assets held for investment2012-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-01-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-01-31No
Opinion of an independent qualified public accountant for this plan2012-01-31Unqualified
Accountancy firm name2012-01-31JORDAN WOOSLEY CRONE & KEATON LTD
Accountancy firm EIN2012-01-31710465329
2011 : COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-01-31$47,200
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-01-31$51,032
Total income from all sources (including contributions)2011-01-31$1,003,956
Total of all expenses incurred2011-01-31$1,003,956
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-01-31$959,065
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-01-31$988,951
Value of total assets at end of year2011-01-31$75,498
Value of total assets at beginning of year2011-01-31$51,032
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-01-31$44,891
Total interest from all sources2011-01-31$108
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-01-31No
Was this plan covered by a fidelity bond2011-01-31No
If this is an individual account plan, was there a blackout period2011-01-31No
Were there any nonexempt tranactions with any party-in-interest2011-01-31No
Contributions received from participants2011-01-31$152,243
Other income not declared elsewhere2011-01-31$14,897
Liabilities. Value of operating payables at beginning of year2011-01-31$35,615
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-01-31No
Value of net income/loss2011-01-31$0
Value of net assets at end of year (total assets less liabilities)2011-01-31$28,298
Value of net assets at beginning of year (total assets less liabilities)2011-01-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-01-31No
Were any leases to which the plan was party in default or uncollectible2011-01-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-01-31$1,506
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-01-31$897
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-01-31$897
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-01-31$108
Expenses. Payments to insurance carriers foe the provision of benefits2011-01-31$279,915
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-01-31No
Was there a failure to transmit to the plan any participant contributions2011-01-31No
Has the plan failed to provide any benefit when due under the plan2011-01-31No
Contributions received in cash from employer2011-01-31$836,708
Employer contributions (assets) at end of year2011-01-31$73,992
Employer contributions (assets) at beginning of year2011-01-31$50,135
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-01-31$679,150
Contract administrator fees2011-01-31$44,891
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-01-31No
Liabilities. Value of benefit claims payable at end of year2011-01-31$47,200
Liabilities. Value of benefit claims payable at beginning of year2011-01-31$15,417
Did the plan have assets held for investment2011-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-01-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-01-31No
Opinion of an independent qualified public accountant for this plan2011-01-31Unqualified
Accountancy firm name2011-01-31JORDAN, WOOSLEY, CRONE, AND KEATON
Accountancy firm EIN2011-01-31710465329

Form 5500 Responses for COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN

2022: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)No
2022-02-01Plan is a collectively bargained planNo
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan funding arrangement – General assets of the sponsorYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – General assets of the sponsorYes
2021: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Submission has been amendedNo
2021-02-01This submission is the final filingNo
2021-02-01This return/report is a short plan year return/report (less than 12 months)No
2021-02-01Plan is a collectively bargained planNo
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan funding arrangement – General assets of the sponsorYes
2021-02-01Plan benefit arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – General assets of the sponsorYes
2020: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan funding arrangement – General assets of the sponsorYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – General assets of the sponsorYes
2019: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan funding arrangement – General assets of the sponsorYes
2019-02-01Plan benefit arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – General assets of the sponsorYes
2018: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan funding arrangement – General assets of the sponsorYes
2018-02-01Plan benefit arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – General assets of the sponsorYes
2017: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan funding arrangement – General assets of the sponsorYes
2017-02-01Plan benefit arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – General assets of the sponsorYes
2016: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan funding arrangement – General assets of the sponsorYes
2016-02-01Plan benefit arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – General assets of the sponsorYes
2015: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan funding arrangement – General assets of the sponsorYes
2015-02-01Plan benefit arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – General assets of the sponsorYes
2014: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan funding arrangement – TrustYes
2014-02-01Plan benefit arrangement – InsuranceYes
2014-02-01Plan benefit arrangement - TrustYes
2013: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan funding arrangement – TrustYes
2013-02-01Plan benefit arrangement – InsuranceYes
2013-02-01Plan benefit arrangement - TrustYes
2012: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan funding arrangement – TrustYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement - TrustYes
2011: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan funding arrangement – TrustYes
2011-02-01Plan benefit arrangement – InsuranceYes
2011-02-01Plan benefit arrangement - TrustYes
2010: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan funding arrangement – TrustYes
2010-02-01Plan benefit arrangement – InsuranceYes
2010-02-01Plan benefit arrangement - TrustYes
2009: COMMUNITY COUNSELING SVCS INC MEDICAL BENEFIT PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01This submission is the final filingNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan funding arrangement – TrustYes
2009-02-01Plan benefit arrangement – InsuranceYes
2009-02-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0B98Y
Policy instance 3
Insurance contract or identification numberGUPR0B98Y
Number of Individuals Covered18
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,995
Total amount of fees paid to insurance companyUSD $968
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,206
Insurance broker organization code?3
Amount paid for insurance broker fees635
Additional information about fees paid to insurance brokerOTHER COMPENSATION
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000004508
Policy instance 1
Insurance contract or identification number000004508
Number of Individuals Covered189
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,010
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,063
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0B98Y
Policy instance 2
Insurance contract or identification numberGLUG0B98Y
Number of Individuals Covered113
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,222
Total amount of fees paid to insurance companyUSD $809
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $212
Amount paid for insurance broker fees503
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTLOB98Y
Policy instance 4
Insurance contract or identification numberGVTLOB98Y
Number of Individuals Covered61
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,688
Total amount of fees paid to insurance companyUSD $751
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $991
Insurance broker organization code?3
Amount paid for insurance broker fees470
Additional information about fees paid to insurance brokerOTHER COMPENSATION
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number061424
Policy instance 5
Insurance contract or identification number061424
Number of Individuals Covered154
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number029365,029366
Policy instance 6
Insurance contract or identification number029365,029366
Number of Individuals Covered132
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDE0B98Y
Policy instance 7
Insurance contract or identification numberGUDE0B98Y
Number of Individuals Covered22
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,207
Total amount of fees paid to insurance companyUSD $493
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $700
Insurance broker organization code?3
Amount paid for insurance broker fees192
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDH0B98Y
Policy instance 8
Insurance contract or identification numberGUDH0B98Y
Number of Individuals Covered19
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $847
Total amount of fees paid to insurance companyUSD $372
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT ONLY VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $510
Insurance broker organization code?3
Amount paid for insurance broker fees160
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0B98Y
Policy instance 9
Insurance contract or identification numberGUG0B98Y
Number of Individuals Covered50
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,614
Total amount of fees paid to insurance companyUSD $1,266
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $16,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $239
Amount paid for insurance broker fees863
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0B98Y
Policy instance 3
Insurance contract or identification numberGUPR0B98Y
Number of Individuals Covered18
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,905
Total amount of fees paid to insurance companyUSD $663
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,905
Insurance broker organization code?3
Amount paid for insurance broker fees346
Additional information about fees paid to insurance brokerOTHER COMPENSATION
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000004508
Policy instance 1
Insurance contract or identification number000004508
Number of Individuals Covered194
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,200
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,200
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0B98Y
Policy instance 2
Insurance contract or identification numberGLUG0B98Y
Number of Individuals Covered115
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,006
Total amount of fees paid to insurance companyUSD $588
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,006
Insurance broker organization code?3
Amount paid for insurance broker fees336
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTLOB98Y
Policy instance 4
Insurance contract or identification numberGVTLOB98Y
Number of Individuals Covered50
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,411
Total amount of fees paid to insurance companyUSD $462
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,411
Insurance broker organization code?3
Amount paid for insurance broker fees235
Additional information about fees paid to insurance brokerADMINISTRATION
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number061424
Policy instance 5
Insurance contract or identification number061424
Number of Individuals Covered153
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number029365,029366
Policy instance 6
Insurance contract or identification number029365,029366
Number of Individuals Covered126
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDE0B98Y
Policy instance 7
Insurance contract or identification numberGUDE0B98Y
Number of Individuals Covered21
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $933
Total amount of fees paid to insurance companyUSD $233
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $933
Insurance broker organization code?3
Amount paid for insurance broker fees233
Additional information about fees paid to insurance brokerADMINISTRATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDH0B98Y
Policy instance 8
Insurance contract or identification numberGUDH0B98Y
Number of Individuals Covered20
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $700
Total amount of fees paid to insurance companyUSD $175
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT ONLY VOLUNTARY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $700
Insurance broker organization code?3
Amount paid for insurance broker fees175
Additional information about fees paid to insurance brokerADMINISTRATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0B98Y
Policy instance 9
Insurance contract or identification numberGUG0B98Y
Number of Individuals Covered58
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,725
Total amount of fees paid to insurance companyUSD $1,075
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,725
Insurance broker organization code?3
Amount paid for insurance broker fees644
Additional information about fees paid to insurance brokerOTHER COMPENSATION
QUALCHOICE LIFE AND HEALTH COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 70998 )
Policy contract number53829
Policy instance 1
Insurance contract or identification number53829
Number of Individuals Covered108
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $16,200
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $503,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,200
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000004508
Policy instance 2
Insurance contract or identification number000004508
Number of Individuals Covered162
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,856
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 $1,856
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0B98Y
Policy instance 3
Insurance contract or identification numberGLUG0B98Y
Number of Individuals Covered107
Insurance policy start date2020-03-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $765
Total amount of fees paid to insurance companyUSD $540
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $765
Insurance broker organization code?3
Amount paid for insurance broker fees540
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUB0B98Y
Policy instance 4
Insurance contract or identification numberGUB0B98Y
Number of Individuals Covered70
Insurance policy start date2020-03-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $1,353
Total amount of fees paid to insurance companyUSD $945
Other welfare benefits providedSHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $13,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,353
Amount paid for insurance broker fees945
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0B98Y
Policy instance 5
Insurance contract or identification numberGUPR0B98Y
Number of Individuals Covered16
Insurance policy start date2020-03-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $1,068
Total amount of fees paid to insurance companyUSD $540
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,068
Insurance broker organization code?3
Amount paid for insurance broker fees540
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTLOB98Y
Policy instance 6
Insurance contract or identification numberGVTLOB98Y
Number of Individuals Covered30
Insurance policy start date2020-03-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $708
Total amount of fees paid to insurance companyUSD $338
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $708
Insurance broker organization code?3
Amount paid for insurance broker fees338
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number061424
Policy instance 7
Insurance contract or identification number061424
Number of Individuals Covered129
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,047
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,047
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4906558
Policy instance 8
Insurance contract or identification numberE4906558
Number of Individuals Covered26
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,459
Total amount of fees paid to insurance companyUSD $119
Welfare Benefit Premiums Paid to CarrierUSD $8,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $576
Insurance broker organization code?3
Amount paid for insurance broker fees67
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTLOB98Y
Policy instance 6
Insurance contract or identification numberGVTLOB98Y
Number of Individuals Covered26
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $846
Total amount of fees paid to insurance companyUSD $413
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $846
Insurance broker organization code?3
Amount paid for insurance broker fees413
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0B98Y
Policy instance 5
Insurance contract or identification numberGUPR0B98Y
Number of Individuals Covered16
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,351
Total amount of fees paid to insurance companyUSD $622
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,351
Insurance broker organization code?3
Amount paid for insurance broker fees622
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUB0B98Y
Policy instance 4
Insurance contract or identification numberGUB0B98Y
Number of Individuals Covered57
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,575
Total amount of fees paid to insurance companyUSD $923
Other welfare benefits providedSHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $15,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,575
Amount paid for insurance broker fees923
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0B98Y
Policy instance 3
Insurance contract or identification numberGLUG0B98Y
Number of Individuals Covered95
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $900
Total amount of fees paid to insurance companyUSD $601
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $900
Insurance broker organization code?3
Amount paid for insurance broker fees601
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000004508
Policy instance 2
Insurance contract or identification number000004508
Number of Individuals Covered165
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,016
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 $1,016
Insurance broker organization code?3
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number53829
Policy instance 1
Insurance contract or identification number53829
Number of Individuals Covered105
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $15,700
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $498,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,700
Insurance broker organization code?3
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number061424
Policy instance 7
Insurance contract or identification number061424
Number of Individuals Covered129
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,016
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,016
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0B98Y
Policy instance 6
Insurance contract or identification numberGUPR0B98Y
Number of Individuals Covered16
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $1,724
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,724
Insurance broker organization code?3
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number061424
Policy instance 8
Insurance contract or identification number061424
Number of Individuals Covered143
Insurance policy end date2018-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUB0B98Y
Policy instance 5
Insurance contract or identification numberGUB0B98Y
Number of Individuals Covered62
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,702
Other welfare benefits providedSHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $17,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,702
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0B98Y
Policy instance 4
Insurance contract or identification numberGLUG0B98Y
Number of Individuals Covered103
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $950
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $950
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4906558
Policy instance 3
Insurance contract or identification numberE4906558
Number of Individuals Covered37
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $9,516
Total amount of fees paid to insurance companyUSD $4,835
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,999
Amount paid for insurance broker fees2282
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000004508
Policy instance 2
Insurance contract or identification number000004508
Number of Individuals Covered173
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,152
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 $638
Insurance broker organization code?3
QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )
Policy contract number53829
Policy instance 1
Insurance contract or identification number53829
Number of Individuals Covered123
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,495
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $678,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,330
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTLOB98Y
Policy instance 7
Insurance contract or identification numberGVTLOB98Y
Number of Individuals Covered32
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $882
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $882
Insurance broker organization code?3
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number061424
Policy instance 1
Insurance contract or identification number061424
Number of Individuals Covered155
Insurance policy end date2017-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameJIMMY MADDIGAN
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number
Policy instance 2
Number of Individuals Covered195
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,343
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 $1,343
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE IINC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605436
Policy instance 3
Insurance contract or identification numberSGD605436
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $3,967
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,967
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605980
Policy instance 4
Insurance contract or identification numberSGD605980
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $1,620
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,620
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604076
Policy instance 6
Insurance contract or identification numberSOK604076
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $528
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $2,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $528
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605253
Policy instance 5
Insurance contract or identification numberSGM605253
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $2,361
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,361
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL33126
Policy instance 7
Insurance contract or identification numberHCL33126
Number of Individuals Covered100
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,410
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $141,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,410
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE
HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 )
Policy contract number028670
Policy instance 1
Insurance contract or identification number028670
Number of Individuals Covered164
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameJIMMY MADDIGAN
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000004508/4508V
Policy instance 2
Insurance contract or identification number000004508/4508V
Number of Individuals Covered233
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,824
Dental Insurance Welfare BenefitYes
Vision 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 $2,824
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE IINC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605436
Policy instance 3
Insurance contract or identification numberSGD605436
Insurance policy start date2015-07-01
Insurance policy end date2016-07-01
Total amount of commissions paid to insurance brokerUSD $3,865
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,865
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK603588
Policy instance 4
Insurance contract or identification numberSOK603588
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $1,928
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,928
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605253
Policy instance 5
Insurance contract or identification numberSGM605253
Insurance policy start date2015-07-01
Insurance policy end date2016-07-01
Total amount of commissions paid to insurance brokerUSD $1,736
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,736
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK604076
Policy instance 6
Insurance contract or identification numberSOK604076
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $132
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $132
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK603588
Policy instance 7
Insurance contract or identification numberSOK603588
Insurance policy start date2015-07-01
Insurance policy end date2016-07-01
Total amount of commissions paid to insurance brokerUSD $203
Other welfare benefits providedACCIDENT DEATH
Welfare Benefit Premiums Paid to CarrierUSD $1,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $203
Insurance broker organization code?3
Insurance broker name
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605845
Policy instance 8
Insurance contract or identification numberSGM605845
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $877
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $877
Insurance broker organization code?4
Insurance broker nameREGIONS INSURANCE INC
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000004508/4508V
Policy instance 2
Insurance contract or identification number000004508/4508V
Number of Individuals Covered152
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $2,877
Dental Insurance Welfare BenefitYes
Vision 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 $1,817
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE IINC
HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 )
Policy contract number028670
Policy instance 1
Insurance contract or identification number028670
Number of Individuals Covered153
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $22,333
Health 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 $22,333
Insurance broker organization code?3
Insurance broker nameJIMMY MADDIGAN
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605436
Policy instance 3
Insurance contract or identification numberSGD605436
Insurance policy start date2014-07-01
Insurance policy end date2015-07-01
Total amount of commissions paid to insurance brokerUSD $4,348
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,348
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK603588
Policy instance 4
Insurance contract or identification numberSOK603588
Insurance policy start date2014-07-01
Insurance policy end date2015-07-01
Total amount of commissions paid to insurance brokerUSD $225
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $225
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605253
Policy instance 5
Insurance contract or identification numberSGM605253
Insurance policy start date2014-07-01
Insurance policy end date2015-07-01
Total amount of commissions paid to insurance brokerUSD $1,859
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,859
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number4508
Policy instance 3
Insurance contract or identification number4508
Number of Individuals Covered209
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,462
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 $1,462
Insurance broker nameROBERT BRACY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number145801
Policy instance 2
Insurance contract or identification number145801
Number of Individuals Covered149
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,781
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,781
Insurance broker organization code?3
Insurance broker nameHEALTHSCOPE BENEFITS, INC.
HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 )
Policy contract number028670
Policy instance 1
Insurance contract or identification number028670
Number of Individuals Covered142
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $19,916
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health 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 $19,916
Insurance broker organization code?3
Insurance broker nameJIMMY MADDIGAN
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number145801
Policy instance 2
Insurance contract or identification number145801
Number of Individuals Covered110
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $1,298
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,298
Insurance broker organization code?3
Insurance broker nameHEALTHSCOPE BENEFITS, INC.
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL16323
Policy instance 1
Insurance contract or identification numberHCL16323
Number of Individuals Covered111
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $2,305
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $249,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,305
Insurance broker organization code?3
Insurance broker nameHEALTHSCOPE BENEFITS, INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number01331
Policy instance 2
Insurance contract or identification number01331
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL16323
Policy instance 1
Insurance contract or identification numberHCL16323
Number of Individuals Covered117
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $244,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number01331
Policy instance 2
Insurance contract or identification number01331
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL16323
Policy instance 1
Insurance contract or identification numberHCL16323
Number of Individuals Covered108
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $296,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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