401k Plan data: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN plan

PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 401k Plan overview

Plan Name	PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN
Plan identification number	503

PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CHILDRENS FOUNDATION OF MID AMERICA, INC. has sponsored the creation of one or more 401k plans.

Company Name: CHILDRENS FOUNDATION OF MID AMERICA, INC.

Employer identification number (EIN): 431699263

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2014-10-01 LINDA BISHOP
503 2013-10-01 LINDA BISHOP
503 2012-10-01 LINDA BISHOP
503 2011-10-01 LINDA BISHOP

Plan id#	Filing Submission Date	Name of Administrator
503	2014-10-01	LINDA BISHOP
503	2013-10-01	LINDA BISHOP
503	2012-10-01	LINDA BISHOP
503	2011-10-01	LINDA BISHOP

Plan Statistics for PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN

401k plan membership statisitcs for PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN

Measure Date Value
2014: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 146
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 0
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 0
2013: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 141
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 146
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 0
Total of all active and inactive participants 2013-10-01 146
2012: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 136
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 141
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 141
2011: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 140
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 136
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 0
Total of all active and inactive participants 2011-10-01 136

Measure	Date	Value
2014: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	146
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	0
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	0
2013: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	141
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	146
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	0
Total of all active and inactive participants	2013-10-01	146
2012: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	136
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	141
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	141
2011: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	140
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	136
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	0
Total of all active and inactive participants	2011-10-01	136

Form 5500 Responses for PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN

2014: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	Yes
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2011: PRESBYTERIAN CHILDREN'S HOMES AND SERVICES OF MISSOURI LIFE INSURANCE PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	First time form 5500 has been submitted	Yes
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

303741

Policy instance

Insurance contract or identification number	303741
Number of Individuals Covered	146
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $1,192
Total amount of fees paid to insurance company	USD $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 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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
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 $13,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,192
Insurance broker organization code?	3
Insurance broker name	THE HAYS GROUP, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10073620

Policy instance

Insurance contract or identification number	10073620
Number of Individuals Covered	141
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $929
Total amount of fees paid to insurance company	USD $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 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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
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 $7,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $929
Insurance broker organization code?	3
Insurance broker name	THE DANIEL & HENRY COMPANY

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10073620

Policy instance

Insurance contract or identification number	10073620
Number of Individuals Covered	136
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $909
Total amount of fees paid to insurance company	USD $171
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 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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
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 $7,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $909
Amount paid for insurance broker fees	171
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	THE DANIEL & HENRY COMPANY

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Company Name:	CHILDRENS FOUNDATION OF MID AMERICA, INC.
Employer identification number (EIN):	431699263
NAIC Classification:	624100
NAIC Description:	Individual and Family Services