401k Plan data: CENTER FOR URBAN COMMUNITY SERVICES plan

CENTER FOR URBAN COMMUNITY SERVICES 401k Plan overview

Plan Name	CENTER FOR URBAN COMMUNITY SERVICES
Plan identification number	502

CENTER FOR URBAN COMMUNITY SERVICES Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Supplemental unemployment Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

CENTER FOR URBAN COMMUNITY SERVICES INC. has sponsored the creation of one or more 401k plans.

Company Name: CENTER FOR URBAN COMMUNITY SERVICES INC.

Employer identification number (EIN): 133687891

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTER FOR URBAN COMMUNITY SERVICES

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-07-01 DOUGLAS JAMES DOUGLAS JAMES 2017-04-06
502 2014-07-01 PAUL GUALANO
502 2013-07-01 PAUL GUALANO
502 2012-07-01 PAUL GUALANO
502 2011-07-01 PAUL GUALANO PAUL GUALANO 2013-01-02
502 2009-07-01 PAUL GUALANO

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2015-07-01	DOUGLAS JAMES	DOUGLAS JAMES	2017-04-06
502	2014-07-01	PAUL GUALANO
502	2013-07-01	PAUL GUALANO
502	2012-07-01	PAUL GUALANO
502	2011-07-01	PAUL GUALANO	PAUL GUALANO	2013-01-02
502	2009-07-01	PAUL GUALANO

Plan Statistics for CENTER FOR URBAN COMMUNITY SERVICES

401k plan membership statisitcs for CENTER FOR URBAN COMMUNITY SERVICES

Measure Date Value
2015: CENTER FOR URBAN COMMUNITY SERVICES 2015 401k membership
Total participants, beginning-of-year 2015-07-01 1,329
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 1,329
Total of all active and inactive participants 2015-07-01 1,329
Total participants 2015-07-01 1,329
2014: CENTER FOR URBAN COMMUNITY SERVICES 2014 401k membership
Total participants, beginning-of-year 2014-07-01 1,517
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 1,517
Total of all active and inactive participants 2014-07-01 1,517
Total participants 2014-07-01 1,517
2013: CENTER FOR URBAN COMMUNITY SERVICES 2013 401k membership
Total participants, beginning-of-year 2013-07-01 1,766
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 1,766
Total of all active and inactive participants 2013-07-01 1,766
Total participants 2013-07-01 1,766
2012: CENTER FOR URBAN COMMUNITY SERVICES 2012 401k membership
Total participants, beginning-of-year 2012-07-01 2,425
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 2,425
Total of all active and inactive participants 2012-07-01 2,425
Total participants 2012-07-01 2,425
2011: CENTER FOR URBAN COMMUNITY SERVICES 2011 401k membership
Total participants, beginning-of-year 2011-07-01 1,813
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 1,813
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 1,813
Total participants 2011-07-01 1,813
2009: CENTER FOR URBAN COMMUNITY SERVICES 2009 401k membership
Total participants, beginning-of-year 2009-07-01 1,206
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 1,206
Total of all active and inactive participants 2009-07-01 1,206
Total participants 2009-07-01 1,206

Measure	Date	Value
2015: CENTER FOR URBAN COMMUNITY SERVICES 2015 401k membership
Total participants, beginning-of-year	2015-07-01	1,329
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	1,329
Total of all active and inactive participants	2015-07-01	1,329
Total participants	2015-07-01	1,329
2014: CENTER FOR URBAN COMMUNITY SERVICES 2014 401k membership
Total participants, beginning-of-year	2014-07-01	1,517
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	1,517
Total of all active and inactive participants	2014-07-01	1,517
Total participants	2014-07-01	1,517
2013: CENTER FOR URBAN COMMUNITY SERVICES 2013 401k membership
Total participants, beginning-of-year	2013-07-01	1,766
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	1,766
Total of all active and inactive participants	2013-07-01	1,766
Total participants	2013-07-01	1,766
2012: CENTER FOR URBAN COMMUNITY SERVICES 2012 401k membership
Total participants, beginning-of-year	2012-07-01	2,425
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	2,425
Total of all active and inactive participants	2012-07-01	2,425
Total participants	2012-07-01	2,425
2011: CENTER FOR URBAN COMMUNITY SERVICES 2011 401k membership
Total participants, beginning-of-year	2011-07-01	1,813
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	1,813
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	1,813
Total participants	2011-07-01	1,813
2009: CENTER FOR URBAN COMMUNITY SERVICES 2009 401k membership
Total participants, beginning-of-year	2009-07-01	1,206
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	1,206
Total of all active and inactive participants	2009-07-01	1,206
Total participants	2009-07-01	1,206

Form 5500 Responses for CENTER FOR URBAN COMMUNITY SERVICES

2015: CENTER FOR URBAN COMMUNITY SERVICES 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: CENTER FOR URBAN COMMUNITY SERVICES 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	No
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: CENTER FOR URBAN COMMUNITY SERVICES 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: CENTER FOR URBAN COMMUNITY SERVICES 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: CENTER FOR URBAN COMMUNITY SERVICES 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
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
2009: CENTER FOR URBAN COMMUNITY SERVICES 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00521780

Policy instance

Insurance contract or identification number	00521780
Number of Individuals Covered	329
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,470
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00500857

Policy instance

Insurance contract or identification number	00500857
Number of Individuals Covered	391
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $30,228
Total amount of fees paid to insurance company	USD $4,655
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	OPTIONAL LIFE, AD&D
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?	No
Amount paid for insurance broker fees	18217
Additional information about fees paid to insurance broker	GROUP INSURANCE AD&D ,LIFE, LONG, TERM, VISION
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS INC NY

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0623459

Policy instance

Insurance contract or identification number	0623459
Number of Individuals Covered	609
Insurance policy start date	2015-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $178,630
Total amount of fees paid to insurance company	USD $17,500
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	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $147,032
Insurance broker organization code?	3
Amount paid for insurance broker fees	17500
Insurance broker name	EMERSON REID, LLC

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

CF17177

Policy instance

Insurance contract or identification number	CF17177
Number of Individuals Covered	503
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $133,000
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	133000
Additional information about fees paid to insurance broker	BONUS/ADMIN SERVICES/NON-MONETARY PAYMENT
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS, INC

AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

NK864

Policy instance

Insurance contract or identification number	NK864
Number of Individuals Covered	58
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $5,939
Total amount of fees paid to insurance company	USD $58
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	No
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
Other welfare benefits provided	VOLUNTARY BENEFIT
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 $5,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $100
Insurance broker organization code?	3
Amount paid for insurance broker fees	19
Insurance broker name	CB PLANS, INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0623459

Policy instance

Insurance contract or identification number	0623459
Number of Individuals Covered	580
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $19,650
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	No
Dental Insurance Welfare Benefit	Yes
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 $196,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,650
Additional information about fees paid to insurance broker	DENTAL
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00500857

Policy instance

Insurance contract or identification number	00500857
Number of Individuals Covered	376
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $19,580
Total amount of fees paid to insurance company	USD $2,293
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	No
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
Other welfare benefits provided	AD&D, LIFE, LONG TERM DISABILITY,OPITIONAL AD&D,OPTIONAL LIFE
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?	No
Amount paid for insurance broker fees	2293
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $19,580
Insurance broker name	CREATIVE BENEFIT PLANS

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0623459

Policy instance

Insurance contract or identification number	0623459
Number of Individuals Covered	544
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $19,395
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	No
Dental Insurance Welfare Benefit	Yes
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 $195,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	19395
Additional information about fees paid to insurance broker	DENTAL
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000400129392

Policy instance

Insurance contract or identification number	000400129392
Number of Individuals Covered	42
Insurance policy start date	2014-01-01
Insurance policy end date	2014-06-01
Total amount of commissions paid to insurance broker	USD $524
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	No
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
Other welfare benefits provided	VOLUNTARY ACCIDENTAL DEATH, VOLUNTARY LIFE
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 $3,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	524
Additional information about fees paid to insurance broker	VOLUNTARY LIFE AND AD&D
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010080795

Policy instance

Insurance contract or identification number	000010080795
Number of Individuals Covered	331
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $4,530
Total amount of fees paid to insurance company	USD $2,651
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	No
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	Yes
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 $53,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,530
Amount paid for insurance broker fees	2651
Additional information about fees paid to insurance broker	MATERIAL PREP, ENROLLMENT,BILLING,CLAIMS EXPERIENCE
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010080794000

Policy instance

Insurance contract or identification number	000010080794000
Number of Individuals Covered	331
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $2,947
Total amount of fees paid to insurance company	USD $2,624
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	No
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
Other welfare benefits provided	AD&D LIFE
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 $52,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,947
Amount paid for insurance broker fees	2624
Additional information about fees paid to insurance broker	ENROLLMENT, MATERIAL PREP, BILLING, CLAIMS EXPERIENCE
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS INC

AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

NK864

Policy instance

Insurance contract or identification number	NK864
Number of Individuals Covered	58
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,114
Total amount of fees paid to insurance company	USD $204
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	No
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
Commission paid to Insurance Broker	USD $446
Amount paid for insurance broker fees	51
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

CF17177

Policy instance

Insurance contract or identification number	CF17177
Number of Individuals Covered	460
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $121,220
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 $3,210,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	121220
Additional information about fees paid to insurance broker	HEALTH
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00958706

Policy instance

Insurance contract or identification number	00958706
Number of Individuals Covered	328
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,325
Total amount of fees paid to insurance company	USD $635
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,325
Insurance broker organization code?	3
Amount paid for insurance broker fees	635
Insurance broker name	CREATIVE BENEFIT PLANS INC NY

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

NK864

Policy instance

Insurance contract or identification number	NK864
Number of Individuals Covered	71
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $10,535
Total amount of fees paid to insurance company	USD $632
Health Insurance Welfare Benefit	No
Other welfare benefits provided	SUPPLEMENTAL VOLUNTARY BENEFIT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,947
Amount paid for insurance broker fees	395
Insurance broker organization code?	3
Insurance broker name	DOMINICK R SIRACUSA

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010080794

Policy instance

Insurance contract or identification number	000010080794
Number of Individuals Covered	324
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,982
Total amount of fees paid to insurance company	USD $2,740
Other welfare benefits provided	VOLUNTARY ACCIDENATL DEATH, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $54,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,982
Amount paid for insurance broker fees	2740
Additional information about fees paid to insurance broker	BILLING, CLAIMS EXPERIENCE,MATERIAL PREP,ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS

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

Policy contract number

742465

Policy instance

Insurance contract or identification number	742465
Number of Individuals Covered	422
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,954
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,954
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	VISION
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010080795

Policy instance

Insurance contract or identification number	000010080795
Number of Individuals Covered	324
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $4,552
Total amount of fees paid to insurance company	USD $2,761
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,552
Amount paid for insurance broker fees	2761
Additional information about fees paid to insurance broker	LTD
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS PLANS

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

623459

Policy instance

Insurance contract or identification number	623459
Number of Individuals Covered	519
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $18,253
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,253
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	DENTAL
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFIT PLANS

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

CF17177

Policy instance

Insurance contract or identification number	CF17177
Number of Individuals Covered	421
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $140,674
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	HEALTH

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00958706

Policy instance

Insurance contract or identification number	00958706
Number of Individuals Covered	326
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $2,276
Total amount of fees paid to insurance company	USD $732
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

Policy instance

Number of Individuals Covered	318
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $2,890
Total amount of fees paid to insurance company	USD $2,451
Other welfare benefits provided	ACCIDENTAL DEATH AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $49,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

Policy instance

Number of Individuals Covered	318
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $4,472
Total amount of fees paid to insurance company	USD $2,472
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

Policy instance

Number of Individuals Covered	60
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $1,373
Other welfare benefits provided	VOLUNTARY ACCIDENTAL DEATH, VOLUUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $9,153

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

623459

Policy instance

Insurance contract or identification number	623459
Number of Individuals Covered	307
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $16,629
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010080795

Policy instance

Insurance contract or identification number	000010080795
Number of Individuals Covered	283
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $4,251
Total amount of fees paid to insurance company	USD $2,251
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

CF17177

Policy instance

Insurance contract or identification number	CF17177
Number of Individuals Covered	398
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $117,873
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00958706

Policy instance

Insurance contract or identification number	00958706
Number of Individuals Covered	410
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,429
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

623459

Policy instance

Insurance contract or identification number	623459
Number of Individuals Covered	510
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $29,703
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010080794

Policy instance

Insurance contract or identification number	000010080794
Number of Individuals Covered	283
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $2,804
Total amount of fees paid to insurance company	USD $2,234
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CENTER FOR URBAN COMMUNITY SERVICES INC.
Employer identification number (EIN):	133687891
NAIC Classification:	624100
NAIC Description:	Individual and Family Services