CAWA ARIZONA HEALTH TRUST BOARD OF TRUSTEES has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: CAWA ARIZONA HEALTH TRUST 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 118 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 118 |
| 2021: CAWA ARIZONA HEALTH TRUST 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 58 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 111 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 1 |
| Total of all active and inactive participants | 2021-01-01 | 112 |
| 2020: CAWA ARIZONA HEALTH TRUST 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 63 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 58 |
| Total of all active and inactive participants | 2020-01-01 | 58 |
| 2019: CAWA ARIZONA HEALTH TRUST 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-18 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-18 | 63 |
| Total of all active and inactive participants | 2019-04-18 | 63 |
| Measure | Date | Value |
|---|
| 2022 : CAWA ARIZONA HEALTH TRUST 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $125,849 |
| Total plan liabilities at beginning of year | 2022-12-31 | $63,060 |
| Total income from all sources | 2022-12-31 | $874,210 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $885,576 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $767,074 |
| Total plan assets at end of year | 2022-12-31 | $77,950 |
| Total plan assets at beginning of year | 2022-12-31 | $26,527 |
| Value of fidelity bond covering the plan | 2022-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $70,459 |
| Net income (gross income less expenses) | 2022-12-31 | $-11,366 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $-47,899 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $-36,533 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $874,210 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $48,043 |
| 2021 : CAWA ARIZONA HEALTH TRUST 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $63,060 |
| Total plan liabilities at beginning of year | 2021-12-31 | $46,381 |
| Total income from all sources | 2021-12-31 | $733,853 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $743,652 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $644,023 |
| Total plan assets at end of year | 2021-12-31 | $26,527 |
| Total plan assets at beginning of year | 2021-12-31 | $19,647 |
| Value of fidelity bond covering the plan | 2021-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2021-12-31 | $9,419 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $52,567 |
| Net income (gross income less expenses) | 2021-12-31 | $-9,799 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $-36,533 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $-26,734 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $724,434 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $47,062 |
| 2020 : CAWA ARIZONA HEALTH TRUST 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $46,381 |
| Total plan liabilities at beginning of year | 2020-12-31 | $51,485 |
| Total income from all sources | 2020-12-31 | $709,406 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $734,381 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $631,227 |
| Total plan assets at end of year | 2020-12-31 | $19,647 |
| Total plan assets at beginning of year | 2020-12-31 | $49,726 |
| Value of fidelity bond covering the plan | 2020-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $49,336 |
| Net income (gross income less expenses) | 2020-12-31 | $-24,975 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $-26,734 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $-1,759 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $709,406 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $53,818 |
| 2019 : CAWA ARIZONA HEALTH TRUST 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $51,485 |
| Total income from all sources | 2019-12-31 | $59,161 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $60,920 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $52,591 |
| Total plan assets at end of year | 2019-12-31 | $49,726 |
| Value of fidelity bond covering the plan | 2019-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $5,963 |
| Net income (gross income less expenses) | 2019-12-31 | $-1,759 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $-1,759 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $59,161 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $2,366 |
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 011688 |
| Policy instance | 3 |
| Insurance contract or identification number | 011688 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 53001 TO 53010 |
| Policy instance | 2 |
| Insurance contract or identification number | 53001 TO 53010 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $759,014 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 30044146 |
| Policy instance | 1 |
| Insurance contract or identification number | 30044146 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 75776 |
| Policy instance | 3 |
| Insurance contract or identification number | 75776 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 53001 TO 53010 |
| Policy instance | 2 |
| Insurance contract or identification number | 53001 TO 53010 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $300 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $673,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 300 | | Additional information about fees paid to insurance broker | SPECIAL INCENTIVE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 30044146 |
| Policy instance | 1 |
| Insurance contract or identification number | 30044146 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 75776 |
| Policy instance | 3 |
| Insurance contract or identification number | 75776 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,298 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 53001 TO 53010 |
| Policy instance | 2 |
| Insurance contract or identification number | 53001 TO 53010 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $400 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $649,439 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 250 | | Additional information about fees paid to insurance broker | SPECIAL INCENTIVE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 30044146 |
| Policy instance | 1 |
| Insurance contract or identification number | 30044146 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 30044146 |
| Policy instance | 1 |
| Insurance contract or identification number | 30044146 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 |
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