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CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 401k Plan overview

Plan NameCENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN
Plan identification number 001

CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.

401k Sponsoring company profile

CENTENNIAL MENTAL HEALTH CENTER INC has sponsored the creation of one or more 401k plans.

Company Name:CENTENNIAL MENTAL HEALTH CENTER INC
Employer identification number (EIN):840781098
NAIC Classification:621420
NAIC Description:Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-07-01
0012021-07-01
0012020-07-01
0012019-07-01
0012018-07-01
0012017-07-01KASSIDY CLOUSE KASSIDY CLOUSE2019-02-05
0012016-07-01KASSIDY CLOUSE KASSIDY CLOUSE2018-03-26
0012015-07-01SHERRI DAVIDSON SHERRI DAVIDSON2017-04-17
0012014-07-01SHERRI DAVIDSON SHERRI DAVIDSON2016-04-15
0012013-07-01SHERRI DAVIDSON SHERRI DAVIDSON2015-04-13
0012012-07-01SHERRI DAVIDSON SHERRI DAVIDSON2014-04-15
0012011-07-01KASSIDY CLOUSE2013-04-15 KASSIDY CLOUSE2013-04-15
0012010-07-01SHERRI K DAVIDSON2012-03-20 SHERRI K DAVIDSON2012-03-20
0012007-07-01SHERRI DAVIDSON

Plan Statistics for CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN

401k plan membership statisitcs for CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN

Measure Date Value
2021: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01274
Total number of active participants reported on line 7a of the Form 55002021-07-01165
Number of retired or separated participants receiving benefits2021-07-0113
Number of other retired or separated participants entitled to future benefits2021-07-0156
Total of all active and inactive participants2021-07-01234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-07-010
Total participants2021-07-01234
Number of participants with account balances2021-07-01170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-07-0113
2020: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01276
Total number of active participants reported on line 7a of the Form 55002020-07-01195
Number of retired or separated participants receiving benefits2020-07-0118
Number of other retired or separated participants entitled to future benefits2020-07-0161
Total of all active and inactive participants2020-07-01274
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-07-010
Total participants2020-07-01274
Number of participants with account balances2020-07-01176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-07-0114
2019: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01257
Total number of active participants reported on line 7a of the Form 55002019-07-01186
Number of retired or separated participants receiving benefits2019-07-0115
Number of other retired or separated participants entitled to future benefits2019-07-0162
Total of all active and inactive participants2019-07-01263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-07-010
Total participants2019-07-01263
Number of participants with account balances2019-07-01171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-07-0122
2018: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01279
Total number of active participants reported on line 7a of the Form 55002018-07-01196
Number of other retired or separated participants entitled to future benefits2018-07-0166
Total of all active and inactive participants2018-07-01262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-07-010
Total participants2018-07-01262
Number of participants with account balances2018-07-01165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-07-0122
2017: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01209
Total number of active participants reported on line 7a of the Form 55002017-07-01137
Number of retired or separated participants receiving benefits2017-07-0118
Number of other retired or separated participants entitled to future benefits2017-07-0166
Total of all active and inactive participants2017-07-01221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-010
Total participants2017-07-01221
Number of participants with account balances2017-07-01189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-07-0114
2016: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01229
Total number of active participants reported on line 7a of the Form 55002016-07-01128
Number of retired or separated participants receiving benefits2016-07-0114
Number of other retired or separated participants entitled to future benefits2016-07-0162
Total of all active and inactive participants2016-07-01204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
Total participants2016-07-01204
Number of participants with account balances2016-07-01164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-07-0123
2015: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01226
Total number of active participants reported on line 7a of the Form 55002015-07-01161
Number of retired or separated participants receiving benefits2015-07-0113
Number of other retired or separated participants entitled to future benefits2015-07-0158
Total of all active and inactive participants2015-07-01232
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-07-010
Total participants2015-07-01232
Number of participants with account balances2015-07-01161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-07-0115
2014: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01193
Total number of active participants reported on line 7a of the Form 55002014-07-01169
Number of retired or separated participants receiving benefits2014-07-018
Number of other retired or separated participants entitled to future benefits2014-07-0146
Total of all active and inactive participants2014-07-01223
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-010
Total participants2014-07-01223
Number of participants with account balances2014-07-01148
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-019
2013: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01179
Total number of active participants reported on line 7a of the Form 55002013-07-01144
Number of retired or separated participants receiving benefits2013-07-0110
Number of other retired or separated participants entitled to future benefits2013-07-0139
Total of all active and inactive participants2013-07-01193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-01193
Number of participants with account balances2013-07-01130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-019
2012: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01171
Total number of active participants reported on line 7a of the Form 55002012-07-01129
Number of retired or separated participants receiving benefits2012-07-018
Number of other retired or separated participants entitled to future benefits2012-07-0133
Total of all active and inactive participants2012-07-01170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-01170
Number of participants with account balances2012-07-01122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-016
2007: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2007 401k membership
Total participants, beginning-of-year2007-07-0148

Financial Data on CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN

Measure Date Value
2022 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total income from all sources (including contributions)2022-06-30$-664,242
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$427,201
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$413,649
Expenses. Certain deemed distributions of participant loans2022-06-30$13,552
Value of total corrective distributions2022-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$473,773
Value of total assets at end of year2022-06-30$4,892,667
Value of total assets at beginning of year2022-06-30$5,984,110
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$0
Total interest from all sources2022-06-30$1,645
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$400,000
If this is an individual account plan, was there a blackout period2022-06-30No
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$308,868
Participant contributions at end of year2022-06-30$26,955
Participant contributions at beginning of year2022-06-30$53,093
Income. Received or receivable in cash from other sources (including rollovers)2022-06-30$10,272
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-06-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$-1,091,443
Value of net assets at end of year (total assets less liabilities)2022-06-30$4,892,667
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$5,984,110
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-06-30$4,865,712
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-06-30$5,931,017
Interest on participant loans2022-06-30$1,645
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-06-30$-1,139,660
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$154,633
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$413,649
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Disclaimer
Accountancy firm name2022-06-30RFARMER, LLC
Accountancy firm EIN2022-06-30840571140
2021 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$0
Total income from all sources (including contributions)2021-06-30$2,006,548
Total loss/gain on sale of assets2021-06-30$0
Total of all expenses incurred2021-06-30$472,894
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$469,377
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$480,788
Value of total assets at end of year2021-06-30$5,984,110
Value of total assets at beginning of year2021-06-30$4,450,456
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$3,517
Total interest from all sources2021-06-30$2,597
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Administrative expenses professional fees incurred2021-06-30$3,517
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$400,000
If this is an individual account plan, was there a blackout period2021-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-06-30$0
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$280,975
Participant contributions at end of year2021-06-30$53,093
Participant contributions at beginning of year2021-06-30$45,371
Income. Received or receivable in cash from other sources (including rollovers)2021-06-30$12,738
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$1,533,654
Value of net assets at end of year (total assets less liabilities)2021-06-30$5,984,110
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$4,450,456
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-06-30$5,931,017
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-06-30$4,405,085
Interest on participant loans2021-06-30$2,597
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-06-30$1,523,163
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30No
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$187,075
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$469,377
Did the plan have assets held for investment2021-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Disclaimer
Accountancy firm name2021-06-30RFARMER, LLC
Accountancy firm EIN2021-06-30840571140
2020 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$0
Total income from all sources (including contributions)2020-06-30$732,236
Total loss/gain on sale of assets2020-06-30$0
Total of all expenses incurred2020-06-30$472,611
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$467,485
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$483,319
Value of total assets at end of year2020-06-30$4,450,456
Value of total assets at beginning of year2020-06-30$4,190,831
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$5,126
Total interest from all sources2020-06-30$2,418
Total dividends received (eg from common stock, registered investment company shares)2020-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Administrative expenses professional fees incurred2020-06-30$5,126
Was this plan covered by a fidelity bond2020-06-30Yes
Value of fidelity bond cover2020-06-30$400,000
If this is an individual account plan, was there a blackout period2020-06-30No
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$292,510
Participant contributions at end of year2020-06-30$45,371
Participant contributions at beginning of year2020-06-30$29,265
Income. Received or receivable in cash from other sources (including rollovers)2020-06-30$102
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$259,625
Value of net assets at end of year (total assets less liabilities)2020-06-30$4,450,456
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$4,190,831
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-06-30$4,405,085
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-06-30$4,161,566
Interest on participant loans2020-06-30$2,418
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-06-30$246,499
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30No
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Contributions received in cash from employer2020-06-30$190,707
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$467,485
Did the plan have assets held for investment2020-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30Yes
Opinion of an independent qualified public accountant for this plan2020-06-30Disclaimer
Accountancy firm name2020-06-30RFARMER,LLC
Accountancy firm EIN2020-06-30840571140
2019 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total income from all sources (including contributions)2019-06-30$721,672
Total loss/gain on sale of assets2019-06-30$0
Total of all expenses incurred2019-06-30$841,386
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$831,026
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$467,144
Value of total assets at end of year2019-06-30$4,190,831
Value of total assets at beginning of year2019-06-30$4,310,545
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$10,360
Total interest from all sources2019-06-30$951
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Administrative expenses professional fees incurred2019-06-30$10,360
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$400,000
If this is an individual account plan, was there a blackout period2019-06-30No
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$190,208
Participant contributions at end of year2019-06-30$29,265
Participant contributions at beginning of year2019-06-30$22,682
Income. Received or receivable in cash from other sources (including rollovers)2019-06-30$1,146
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$-119,714
Value of net assets at end of year (total assets less liabilities)2019-06-30$4,190,831
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$4,310,545
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-06-30$4,161,566
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-06-30$4,287,863
Interest on participant loans2019-06-30$951
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-06-30$253,577
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$275,790
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$831,026
Did the plan have assets held for investment2019-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30Yes
Opinion of an independent qualified public accountant for this plan2019-06-30Disclaimer
Accountancy firm name2019-06-30RFARMER,LLC
Accountancy firm EIN2019-06-30840571140
2018 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$0
Total income from all sources (including contributions)2018-06-30$681,442
Total loss/gain on sale of assets2018-06-30$0
Total of all expenses incurred2018-06-30$111,327
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-06-30$111,327
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-06-30$372,996
Value of total assets at end of year2018-06-30$4,310,545
Value of total assets at beginning of year2018-06-30$3,740,430
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-06-30$0
Total interest from all sources2018-06-30$669
Total dividends received (eg from common stock, registered investment company shares)2018-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-06-30No
Was this plan covered by a fidelity bond2018-06-30Yes
Value of fidelity bond cover2018-06-30$400,000
If this is an individual account plan, was there a blackout period2018-06-30No
Were there any nonexempt tranactions with any party-in-interest2018-06-30No
Contributions received from participants2018-06-30$238,847
Participant contributions at end of year2018-06-30$22,682
Participant contributions at beginning of year2018-06-30$19,441
Participant contributions at beginning of year2018-06-30$20,681
Income. Received or receivable in cash from other sources (including rollovers)2018-06-30$22,031
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-06-30$659
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Value of net income/loss2018-06-30$570,115
Value of net assets at end of year (total assets less liabilities)2018-06-30$4,310,545
Value of net assets at beginning of year (total assets less liabilities)2018-06-30$3,740,430
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-06-30No
Were any leases to which the plan was party in default or uncollectible2018-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-06-30$4,287,863
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-06-30$3,685,898
Interest on participant loans2018-06-30$669
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-06-30$307,777
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-06-30No
Was there a failure to transmit to the plan any participant contributions2018-06-30No
Has the plan failed to provide any benefit when due under the plan2018-06-30No
Contributions received in cash from employer2018-06-30$112,118
Employer contributions (assets) at beginning of year2018-06-30$13,751
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-06-30$111,327
Did the plan have assets held for investment2018-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-06-30Yes
Opinion of an independent qualified public accountant for this plan2018-06-30Disclaimer
Accountancy firm name2018-06-30CBJ CERTIFIED PUBLIC ACCOUNTANTS
Accountancy firm EIN2018-06-30830579218
2017 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$0
Total income from all sources (including contributions)2017-06-30$857,025
Total loss/gain on sale of assets2017-06-30$0
Total of all expenses incurred2017-06-30$276,891
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$272,243
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$450,600
Value of total assets at end of year2017-06-30$3,740,430
Value of total assets at beginning of year2017-06-30$3,160,296
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$4,648
Total interest from all sources2017-06-30$950
Total dividends received (eg from common stock, registered investment company shares)2017-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-06-30No
Administrative expenses professional fees incurred2017-06-30$4,648
Was this plan covered by a fidelity bond2017-06-30Yes
Value of fidelity bond cover2017-06-30$400,000
If this is an individual account plan, was there a blackout period2017-06-30No
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$251,005
Participant contributions at end of year2017-06-30$19,441
Participant contributions at beginning of year2017-06-30$21,911
Participant contributions at end of year2017-06-30$20,681
Participant contributions at beginning of year2017-06-30$21,114
Income. Received or receivable in cash from other sources (including rollovers)2017-06-30$39,238
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-06-30$659
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Value of net income/loss2017-06-30$580,134
Value of net assets at end of year (total assets less liabilities)2017-06-30$3,740,430
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$3,160,296
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-06-30No
Were any leases to which the plan was party in default or uncollectible2017-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-06-30$3,685,898
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-06-30$2,930,517
Interest on participant loans2017-06-30$950
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-06-30$173,996
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-06-30$405,475
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-06-30No
Was there a failure to transmit to the plan any participant contributions2017-06-30No
Has the plan failed to provide any benefit when due under the plan2017-06-30No
Contributions received in cash from employer2017-06-30$160,357
Employer contributions (assets) at end of year2017-06-30$13,751
Employer contributions (assets) at beginning of year2017-06-30$12,758
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-06-30$272,243
Did the plan have assets held for investment2017-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-06-30Yes
Opinion of an independent qualified public accountant for this plan2017-06-30Disclaimer
Accountancy firm name2017-06-30BAIN & JONES, CPAS
Accountancy firm EIN2017-06-30273672189
2016 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$0
Total income from all sources (including contributions)2016-06-30$366,521
Total loss/gain on sale of assets2016-06-30$0
Total of all expenses incurred2016-06-30$312,727
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$312,727
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$441,457
Value of total assets at end of year2016-06-30$3,160,296
Value of total assets at beginning of year2016-06-30$3,106,502
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$0
Total interest from all sources2016-06-30$1,171
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$0
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$400,000
If this is an individual account plan, was there a blackout period2016-06-30No
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Contributions received from participants2016-06-30$258,530
Participant contributions at end of year2016-06-30$21,911
Participant contributions at beginning of year2016-06-30$27,196
Participant contributions at end of year2016-06-30$21,114
Income. Received or receivable in cash from other sources (including rollovers)2016-06-30$18,715
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$53,794
Value of net assets at end of year (total assets less liabilities)2016-06-30$3,160,296
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$3,106,502
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-06-30$2,930,517
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-06-30$2,921,640
Interest on participant loans2016-06-30$1,171
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-06-30$173,996
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-06-30$157,666
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-06-30$-76,107
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30No
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$164,212
Employer contributions (assets) at end of year2016-06-30$12,758
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-06-30$312,727
Did the plan have assets held for investment2016-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30Yes
Opinion of an independent qualified public accountant for this plan2016-06-30Disclaimer
Accountancy firm name2016-06-30BAIN & JONES, CPAS
Accountancy firm EIN2016-06-30273672189
2015 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$0
Total income from all sources (including contributions)2015-06-30$465,122
Total loss/gain on sale of assets2015-06-30$0
Total of all expenses incurred2015-06-30$382,510
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$382,510
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$426,654
Value of total assets at end of year2015-06-30$3,106,502
Value of total assets at beginning of year2015-06-30$3,023,890
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$0
Total interest from all sources2015-06-30$1,181
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$0
Was this plan covered by a fidelity bond2015-06-30No
If this is an individual account plan, was there a blackout period2015-06-30No
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Contributions received from participants2015-06-30$235,356
Participant contributions at end of year2015-06-30$27,196
Participant contributions at beginning of year2015-06-30$31,511
Income. Received or receivable in cash from other sources (including rollovers)2015-06-30$41,158
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$82,612
Value of net assets at end of year (total assets less liabilities)2015-06-30$3,106,502
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$3,023,890
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$2,921,640
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-06-30$2,843,660
Interest on participant loans2015-06-30$1,181
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-06-30$157,666
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-06-30$148,719
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-06-30$37,287
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30No
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$150,140
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-06-30$382,510
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30Yes
Opinion of an independent qualified public accountant for this plan2015-06-30Disclaimer
Accountancy firm name2015-06-30BAIN & JONES, CAPS
Accountancy firm EIN2015-06-30273672189
2014 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$0
Total income from all sources (including contributions)2014-06-30$665,220
Total loss/gain on sale of assets2014-06-30$0
Total of all expenses incurred2014-06-30$148,463
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$148,463
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$322,894
Value of total assets at end of year2014-06-30$3,023,890
Value of total assets at beginning of year2014-06-30$2,507,133
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$0
Total interest from all sources2014-06-30$1,500
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$0
Was this plan covered by a fidelity bond2014-06-30No
If this is an individual account plan, was there a blackout period2014-06-30No
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$196,525
Participant contributions at end of year2014-06-30$31,511
Participant contributions at beginning of year2014-06-30$40,014
Participant contributions at beginning of year2014-06-30$31,914
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$516,757
Value of net assets at end of year (total assets less liabilities)2014-06-30$3,023,890
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$2,507,133
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-06-30$2,843,660
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$2,239,437
Interest on participant loans2014-06-30$1,500
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-06-30$148,719
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-06-30$174,930
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-06-30$340,826
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30No
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Contributions received in cash from employer2014-06-30$126,369
Employer contributions (assets) at beginning of year2014-06-30$20,838
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$148,463
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30Yes
Opinion of an independent qualified public accountant for this plan2014-06-30Disclaimer
Accountancy firm name2014-06-30BAIN & JONES, CPAS
Accountancy firm EIN2014-06-30273672189
2013 : CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total income from all sources (including contributions)2013-06-30$513,128
Total loss/gain on sale of assets2013-06-30$0
Total of all expenses incurred2013-06-30$131,129
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$128,820
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$308,900
Value of total assets at end of year2013-06-30$2,507,133
Value of total assets at beginning of year2013-06-30$2,125,134
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$2,309
Total interest from all sources2013-06-30$1,989
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$0
Was this plan covered by a fidelity bond2013-06-30No
If this is an individual account plan, was there a blackout period2013-06-30No
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$181,015
Participant contributions at end of year2013-06-30$40,014
Participant contributions at beginning of year2013-06-30$14,388
Participant contributions at end of year2013-06-30$31,914
Participant contributions at beginning of year2013-06-30$28,541
Income. Received or receivable in cash from other sources (including rollovers)2013-06-30$8,057
Administrative expenses (other) incurred2013-06-30$2,309
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$381,999
Value of net assets at end of year (total assets less liabilities)2013-06-30$2,507,133
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$2,125,134
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-06-30$2,239,437
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-06-30$1,917,781
Interest on participant loans2013-06-30$1,054
Interest earned on other investments2013-06-30$935
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-06-30$174,930
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-06-30$144,277
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-06-30$202,239
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30No
Was there a failure to transmit to the plan any participant contributions2013-06-30No
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Contributions received in cash from employer2013-06-30$119,828
Employer contributions (assets) at end of year2013-06-30$20,838
Employer contributions (assets) at beginning of year2013-06-30$20,147
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$128,820
Did the plan have assets held for investment2013-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30Yes
Opinion of an independent qualified public accountant for this plan2013-06-30Disclaimer
Accountancy firm name2013-06-30BAIN & JONES, CPAS
Accountancy firm EIN2013-06-30273672189

Form 5500 Responses for CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN

2021: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2007: CENTENNIAL MENTAL HEALTH CENTER INC TAX SHELTERED VOLUNTARY 403(B) PLAN 2007 form 5500 responses
2007-07-01Type of plan entitySingle employer plan
2007-07-01Submission has been amendedNo
2007-07-01This submission is the final filingNo
2007-07-01This return/report is a short plan year return/report (less than 12 months)No
2007-07-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $422
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $422
Insurance broker organization code?3
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $397
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $397
Amount paid for insurance broker fees0
Insurance broker organization code?3
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $581
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $581
Amount paid for insurance broker fees0
Insurance broker organization code?3
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $692
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $692
Insurance broker organization code?3
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Number of Individuals Covered6
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $700
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Number of Individuals Covered6
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Are there contracts with allocated funds for individual policies?No
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 Administration1
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $831
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $831
Insurance broker organization code?3
Insurance broker nameSAGEPOINT FINANCIAL INC
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Number of Individuals Covered6
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Are there contracts with allocated funds for individual policies?No
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 Administration1
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Number of Individuals Covered148
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $756
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $756
Insurance broker organization code?3
Insurance broker nameSAGEPOINT FINANCIAL INC
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Number of Individuals Covered6
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $836
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $836
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSAGEPOINT FINANCIAL INC
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number40938
Policy instance 2
Insurance contract or identification number40938
Number of Individuals Covered29
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-DV4H
Policy instance 1
Insurance contract or identification numberGAP-B2-DV4H
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $786
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $786
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSAGEPOINT FINANCIAL INC

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