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COMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameCOMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN
Plan identification number 505

COMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

COMMUNITY ACTION PROGRAM - BELKNAP MERRIMACK COUNTIES INC. has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY ACTION PROGRAM - BELKNAP MERRIMACK COUNTIES INC.
Employer identification number (EIN):020270376
NAIC Classification:624200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-07-01CHRISTINE MARIE2023-10-26

Plan Statistics for COMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for COMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: COMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01156
Total number of active participants reported on line 7a of the Form 55002022-07-01173
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01173
Number of employers contributing to the scheme2022-07-010

Form 5500 Responses for COMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN

2022: COMMUNITY ACTION PROGRAM BELKNAP-MERRIMACK COUNTIES, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01First time form 5500 has been submittedYes
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number13650
Policy instance 1
Insurance contract or identification number13650
Number of Individuals Covered206
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $3,940
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,652
Amount paid for insurance broker fees0
Insurance broker organization code?3
RED TREE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 13646 )
Policy contract number913650
Policy instance 2
Insurance contract or identification number913650
Number of Individuals Covered204
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $1,026
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $827
Amount paid for insurance broker fees0
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169197
Policy instance 3
Insurance contract or identification number169197
Number of Individuals Covered173
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $8,450
Total amount of fees paid to insurance companyUSD $828
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $3,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,042
Amount paid for insurance broker fees824
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 )
Policy contract number1134990000
Policy instance 4
Insurance contract or identification number1134990000
Number of Individuals Covered186
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $64,722
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $1,530,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $64,722
Amount paid for insurance broker fees0
Insurance broker organization code?3

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