401k Plan data: KINGS VIEW SUPPLEMENTAL GAP POLICY plan

KINGS VIEW SUPPLEMENTAL GAP POLICY 401k Plan overview

Plan Name	KINGS VIEW SUPPLEMENTAL GAP POLICY
Plan identification number	506

KINGS VIEW SUPPLEMENTAL GAP POLICY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

KINGS VIEW has sponsored the creation of one or more 401k plans.

Company Name: KINGS VIEW

Employer identification number (EIN): 941412648

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

Additional information about KINGS VIEW

Jurisdiction of Incorporation: New Jersey Division of Revenue and Enterprise Services

Incorporation Date:

Company Identification Number: 0100442212

More information about KINGS VIEW

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KINGS VIEW SUPPLEMENTAL GAP POLICY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2014-07-01 JIM S. RODRIGUEZ
506 2013-07-01 JIM S. RODRIGUEZ
506 2012-07-01 JIM S. RODRIGUEZ
506 2011-07-01 JIM S. RODRIGUEZ

Plan id#	Filing Submission Date	Name of Administrator
506	2014-07-01	JIM S. RODRIGUEZ
506	2013-07-01	JIM S. RODRIGUEZ
506	2012-07-01	JIM S. RODRIGUEZ
506	2011-07-01	JIM S. RODRIGUEZ

Plan Statistics for KINGS VIEW SUPPLEMENTAL GAP POLICY

401k plan membership statisitcs for KINGS VIEW SUPPLEMENTAL GAP POLICY

Measure Date Value
2014: KINGS VIEW SUPPLEMENTAL GAP POLICY 2014 401k membership
Total participants, beginning-of-year 2014-07-01 142
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 0
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 0
2013: KINGS VIEW SUPPLEMENTAL GAP POLICY 2013 401k membership
Total participants, beginning-of-year 2013-07-01 142
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 142
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 142
2012: KINGS VIEW SUPPLEMENTAL GAP POLICY 2012 401k membership
Total participants, beginning-of-year 2012-07-01 142
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 142
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 142
2011: KINGS VIEW SUPPLEMENTAL GAP POLICY 2011 401k membership
Total participants, beginning-of-year 2011-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 142
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 142

Measure	Date	Value
2014: KINGS VIEW SUPPLEMENTAL GAP POLICY 2014 401k membership
Total participants, beginning-of-year	2014-07-01	142
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	0
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	0
2013: KINGS VIEW SUPPLEMENTAL GAP POLICY 2013 401k membership
Total participants, beginning-of-year	2013-07-01	142
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	142
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	142
2012: KINGS VIEW SUPPLEMENTAL GAP POLICY 2012 401k membership
Total participants, beginning-of-year	2012-07-01	142
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	142
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	142
2011: KINGS VIEW SUPPLEMENTAL GAP POLICY 2011 401k membership
Total participants, beginning-of-year	2011-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	142
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	142

Form 5500 Responses for KINGS VIEW SUPPLEMENTAL GAP POLICY

2014: KINGS VIEW SUPPLEMENTAL GAP POLICY 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	Yes
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: KINGS VIEW SUPPLEMENTAL GAP POLICY 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: KINGS VIEW SUPPLEMENTAL GAP POLICY 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: KINGS VIEW SUPPLEMENTAL GAP POLICY 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	First time form 5500 has been submitted	Yes
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

MG-115OP120519

Policy instance

Insurance contract or identification number	MG-115OP120519
Number of Individuals Covered	142
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $24,106
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $160,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,106
Insurance broker organization code?	3
Insurance broker name	DER MANOUEL INS. AND FIN. SERVICES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

MG-115 OP120519

Policy instance

Insurance contract or identification number	MG-115 OP120519
Number of Individuals Covered	142
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $25,758
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $171,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,758
Insurance broker organization code?	3
Insurance broker name	DER MANOUEL INS. AND FIN. SERVICES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

MG115/OP120519

Policy instance

Insurance contract or identification number	MG115/OP120519
Number of Individuals Covered	142
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $25,049
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $166,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,049
Insurance broker organization code?	3
Insurance broker name	DER MANOUEL INS. AND FIN. SERVICES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

MG115/OP120519

Policy instance

Insurance contract or identification number	MG115/OP120519
Number of Individuals Covered	142
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $22,418
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $149,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,418
Insurance broker organization code?	3
Insurance broker name	DER MANOUEL INS. AND FIN. SERVICES

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Company Name:	KINGS VIEW
Employer identification number (EIN):	941412648
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers

Jurisdiction of Incorporation:	New Jersey Division of Revenue and Enterprise Services
Incorporation Date:
Company Identification Number:	0100442212