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| Plan Name | COMMUNITY INTEGRATED SERVICES GROUP VOL. LIFE AND DISABILITY PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | COMMUNITY INTEGRATED SERVICES, INC. |
| Employer identification number (EIN): | 200006353 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
Additional information about COMMUNITY INTEGRATED SERVICES, INC.
| Jurisdiction of Incorporation: | State of Delaware Division of Corporations |
| Incorporation Date: | |
| Company Identification Number: | 3378077 |
More information about COMMUNITY INTEGRATED SERVICES, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2021-08-01 | CHARLES MORTON | 2023-02-16 | ||
| 504 | 2021-08-01 | CHARLES MORTON | 2024-04-23 |
| Measure | Date | Value |
|---|---|---|
| 2021: COMMUNITY INTEGRATED SERVICES GROUP VOL. LIFE AND DISABILITY PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-08-01 | 307 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 215 |
| Number of retired or separated participants receiving benefits | 2021-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 0 |
| Total of all active and inactive participants | 2021-08-01 | 215 |
| Number of employers contributing to the scheme | 2021-08-01 | 0 |
| 2021: COMMUNITY INTEGRATED SERVICES GROUP VOL. LIFE AND DISABILITY PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | First time form 5500 has been submitted | Yes |
| 2021-08-01 | Submission has been amended | Yes |
| 2021-08-01 | This submission is the final filing | Yes |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 284816 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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