401k Plan data: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN plan

CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 401k Plan overview

Plan Name	CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN
Plan identification number	504

CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

CENTERS FOR YOUTH AND FAMILIES, INC has sponsored the creation of one or more 401k plans.

Company Name: CENTERS FOR YOUTH AND FAMILIES, INC

Employer identification number (EIN): 710415350

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-01-01 BARBARA MCCRORY 2023-10-16 BARBARA MCCRORY 2023-10-16
504 2021-01-01 BARBARA MCCRORY 2022-10-17 BARBARA MCCRORY 2022-10-17
504 2020-01-01 BARBARA MCCRORY 2021-10-12 BARBARA MCCRORY 2021-10-12
504 2019-01-01 BARBARA MCCRORY 2020-10-15 BARBARA MCCRORY 2020-10-15
504 2018-01-01 BARBARA MCCRORY 2019-10-14 BARBARA MCCRORY 2019-10-14
504 2017-01-01
504 2015-01-01
504 2014-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2022-01-01	BARBARA MCCRORY	2023-10-16	BARBARA MCCRORY	2023-10-16
504	2021-01-01	BARBARA MCCRORY	2022-10-17	BARBARA MCCRORY	2022-10-17
504	2020-01-01	BARBARA MCCRORY	2021-10-12	BARBARA MCCRORY	2021-10-12
504	2019-01-01	BARBARA MCCRORY	2020-10-15	BARBARA MCCRORY	2020-10-15
504	2018-01-01	BARBARA MCCRORY	2019-10-14	BARBARA MCCRORY	2019-10-14
504	2017-01-01
504	2015-01-01
504	2014-01-01

Plan Statistics for CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN

401k plan membership statisitcs for CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN

Measure Date Value
2022: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 155
Total of all active and inactive participants 2022-01-01 155
2021: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 160
Total of all active and inactive participants 2021-01-01 160
2020: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 163
Total of all active and inactive participants 2020-01-01 163
2019: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 149
Total of all active and inactive participants 2019-01-01 149
2018: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 145
Total of all active and inactive participants 2018-01-01 145
2017: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 139
Total of all active and inactive participants 2017-01-01 139
2015: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 147
Total of all active and inactive participants 2015-01-01 147
2014: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 144
Total of all active and inactive participants 2014-01-01 144

Measure	Date	Value
2022: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	155
Total of all active and inactive participants	2022-01-01	155
2021: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	160
Total of all active and inactive participants	2021-01-01	160
2020: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	163
Total of all active and inactive participants	2020-01-01	163
2019: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	149
Total of all active and inactive participants	2019-01-01	149
2018: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	145
Total of all active and inactive participants	2018-01-01	145
2017: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	139
Total of all active and inactive participants	2017-01-01	139
2015: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	147
Total of all active and inactive participants	2015-01-01	147
2014: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	144
Total of all active and inactive participants	2014-01-01	144

Form 5500 Responses for CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN

2022: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2015: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CENTERS FOR YOUTH & FAMILIES WELFARE BENEFIT UMBRELLA PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

5 STAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77879 )

Policy contract number

01375

Policy instance

Insurance contract or identification number	01375
Number of Individuals Covered	59
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,375
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $19,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,673
Insurance broker organization code?	3

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

Policy contract number

00508316

Policy instance

Insurance contract or identification number	00508316
Number of Individuals Covered	123
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $17,751
Total amount of fees paid to insurance company	USD $5,591
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D,CANCER,STD,VOL. CRIT. ILL.
Welfare Benefit Premiums Paid to Carrier	USD $79,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,751
Amount paid for insurance broker fees	5591
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00003666V

Policy instance

Insurance contract or identification number	00003666V
Number of Individuals Covered	215
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,342
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,342
Insurance broker organization code?	3

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

52786

Policy instance

Insurance contract or identification number	52786
Number of Individuals Covered	246
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $70,285
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,405,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,285
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000003666

Policy instance

Insurance contract or identification number	000003666
Number of Individuals Covered	266
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,033
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,033
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000003666

Policy instance

Insurance contract or identification number	000003666
Number of Individuals Covered	227
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,954
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,954
Insurance broker organization code?	3

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

52786

Policy instance

Insurance contract or identification number	52786
Number of Individuals Covered	229
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $66,447
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,328,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,447

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00003666V

Policy instance

Insurance contract or identification number	00003666V
Number of Individuals Covered	187
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,272
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,272
Insurance broker organization code?	3

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

Policy contract number

00508316

Policy instance

Insurance contract or identification number	00508316
Number of Individuals Covered	123
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $24,406
Total amount of fees paid to insurance company	USD $7,205
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D,CANCER,STD,VOL. CRIT. ILL.
Welfare Benefit Premiums Paid to Carrier	USD $110,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,406
Amount paid for insurance broker fees	7205
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000003666

Policy instance

Insurance contract or identification number	000003666
Number of Individuals Covered	258
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,717
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,717
Insurance broker organization code?	3

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

52786

Policy instance

Insurance contract or identification number	52786
Number of Individuals Covered	257
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $66,880
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,337,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,880

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00003666V

Policy instance

Insurance contract or identification number	00003666V
Number of Individuals Covered	208
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,244
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,244
Insurance broker organization code?	3

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

Policy contract number

00508316

Policy instance

Insurance contract or identification number	00508316
Number of Individuals Covered	108
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $21,783
Total amount of fees paid to insurance company	USD $5,247
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D,CANCER,STD,VOL. CRIT. ILL.
Welfare Benefit Premiums Paid to Carrier	USD $98,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,783
Amount paid for insurance broker fees	5247
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000003666

Policy instance

Insurance contract or identification number	000003666
Number of Individuals Covered	233
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,179
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,179
Insurance broker organization code?	3

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

Policy contract number

00508316

Policy instance

Insurance contract or identification number	00508316
Number of Individuals Covered	117
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $18,388
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D,CANCER,STD,VOL. CRIT. ILL.
Welfare Benefit Premiums Paid to Carrier	USD $23,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,339
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00003666V

Policy instance

Insurance contract or identification number	00003666V
Number of Individuals Covered	128
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,345
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,345
Insurance broker organization code?	3

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

52786

Policy instance

Insurance contract or identification number	52786
Number of Individuals Covered	228
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $65,964
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,317,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,964

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00003666V

Policy instance

Insurance contract or identification number	00003666V
Number of Individuals Covered	191
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,345
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,345
Insurance broker organization code?	3

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

Policy contract number

00508316

Policy instance

Insurance contract or identification number	00508316
Number of Individuals Covered	134
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $18,388
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D,CANCER,STD,VOL. CRIT. ILL.
Welfare Benefit Premiums Paid to Carrier	USD $83,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,339
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000003666

Policy instance

Insurance contract or identification number	000003666
Number of Individuals Covered	254
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,195
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,195
Insurance broker organization code?	3

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

52786

Policy instance

Insurance contract or identification number	52786
Number of Individuals Covered	244
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $65,183
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,302,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,183
Insurance broker organization code?	3

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

Policy contract number

00508316

Policy instance

Insurance contract or identification number	00508316
Number of Individuals Covered	34
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,594
Total amount of fees paid to insurance company	USD $1,952
Other welfare benefits provided	ACCIDENT, CANCER, VOL. CRIT. ILL.
Welfare Benefit Premiums Paid to Carrier	USD $27,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,539
Amount paid for insurance broker fees	1952
Insurance broker organization code?	3
Insurance broker name	ASHFORD MID SOUTH LLC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000003666

Policy instance

Insurance contract or identification number	000003666
Number of Individuals Covered	245
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $11,687
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,687
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

S0K600597

Policy instance

Insurance contract or identification number	S0K600597
Number of Individuals Covered	153
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $431
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $431
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

SGM601142

Policy instance

Insurance contract or identification number	SGM601142
Number of Individuals Covered	158
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,773
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,773
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

SGD601010

Policy instance

Insurance contract or identification number	SGD601010
Number of Individuals Covered	158
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $9,749
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,749
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

52786

Policy instance

Insurance contract or identification number	52786
Number of Individuals Covered	219
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $57,342
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,146,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,342
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00003666V

Policy instance

Insurance contract or identification number	00003666V
Number of Individuals Covered	150
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,054
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,054
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

VDT961776

Policy instance

Insurance contract or identification number	VDT961776
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,430
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,430
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000003666

Policy instance

Insurance contract or identification number	000003666
Number of Individuals Covered	221
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,302
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,302
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

S0K600597

Policy instance

Insurance contract or identification number	S0K600597
Number of Individuals Covered	147
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $376
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $376
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

SGM601142

Policy instance

Insurance contract or identification number	SGM601142
Number of Individuals Covered	147
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,954
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,954
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

SGD601010

Policy instance

Insurance contract or identification number	SGD601010
Number of Individuals Covered	147
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,641
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,641
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

52786

Policy instance

Insurance contract or identification number	52786
Number of Individuals Covered	196
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $72,186
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,357,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,186
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

VDT961776

Policy instance

Insurance contract or identification number	VDT961776
Number of Individuals Covered	25
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,276
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,276
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

00003666V

Policy instance

Insurance contract or identification number	00003666V
Number of Individuals Covered	124
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,443
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,443
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000003666

Policy instance

Insurance contract or identification number	000003666
Number of Individuals Covered	283
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,765
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,765
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

52786

Policy instance

Insurance contract or identification number	52786
Number of Individuals Covered	262
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $73,451
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,342,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $73,451
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

SGD601010

Policy instance

Insurance contract or identification number	SGD601010
Number of Individuals Covered	144
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,179
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,179
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

SGM601142

Policy instance

Insurance contract or identification number	SGM601142
Number of Individuals Covered	144
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,369
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,369
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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

Policy contract number

S0K600597

Policy instance

Insurance contract or identification number	S0K600597
Number of Individuals Covered	144
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $520
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $520
Insurance broker organization code?	3
Insurance broker name	THE HATCHER AGENCY

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Company Name:	CENTERS FOR YOUTH AND FAMILIES, INC
Employer identification number (EIN):	710415350
NAIC Classification:	624100
NAIC Description:	Individual and Family Services