401k Plan data: NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN plan

NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 401k Plan overview

Plan Name	NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN
Plan identification number	002

NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

NORTH COMMUNITY COUNSELING CENTERS, has sponsored the creation of one or more 401k plans.

Company Name: NORTH COMMUNITY COUNSELING CENTERS,

Employer identification number (EIN): 311258042

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2020-07-01
002 2019-07-01
002 2018-07-01 LINDSAY CORNELIUS 2020-04-14
002 2017-07-01 LINDSAY CORNELIUS 2020-04-14
002 2016-07-01 LINDSAY CORNELIUS 2020-04-13
002 2015-07-01 FRANK BERGER 2016-11-30
002 2014-07-01 FRANK BERGER 2016-04-06
002 2013-07-01 DAVID KITTREDGE 2015-02-27
002 2012-07-01 DAVID KITTREDGE 2014-04-15
002 2011-07-01 DAVID KITTREDGE 2013-04-12
002 2010-07-01 DAVID KITTREDGE 2012-04-02

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2020-07-01
002	2019-07-01
002	2018-07-01	LINDSAY CORNELIUS	2020-04-14
002	2017-07-01	LINDSAY CORNELIUS	2020-04-14
002	2016-07-01	LINDSAY CORNELIUS	2020-04-13
002	2015-07-01	FRANK BERGER	2016-11-30
002	2014-07-01	FRANK BERGER	2016-04-06
002	2013-07-01	DAVID KITTREDGE	2015-02-27
002	2012-07-01	DAVID KITTREDGE	2014-04-15
002	2011-07-01	DAVID KITTREDGE	2013-04-12
002	2010-07-01	DAVID KITTREDGE	2012-04-02

Plan Statistics for NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN

401k plan membership statisitcs for NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN

Measure Date Value
2020: NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 144
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 117
Number of retired or separated participants receiving benefits 2020-07-01 3
Number of other retired or separated participants entitled to future benefits 2020-07-01 28
Total of all active and inactive participants 2020-07-01 148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-07-01 0
Total participants 2020-07-01 148
Number of participants with account balances 2020-07-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-07-01 1
2019: NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 144
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 117
Number of retired or separated participants receiving benefits 2019-07-01 3
Number of other retired or separated participants entitled to future benefits 2019-07-01 27
Total of all active and inactive participants 2019-07-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-07-01 0
Total participants 2019-07-01 147
Number of participants with account balances 2019-07-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-07-01 4

Measure	Date	Value
2020: NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	144
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	117
Number of retired or separated participants receiving benefits	2020-07-01	3
Number of other retired or separated participants entitled to future benefits	2020-07-01	28
Total of all active and inactive participants	2020-07-01	148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-07-01	0
Total participants	2020-07-01	148
Number of participants with account balances	2020-07-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-07-01	1
2019: NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	144
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	117
Number of retired or separated participants receiving benefits	2019-07-01	3
Number of other retired or separated participants entitled to future benefits	2019-07-01	27
Total of all active and inactive participants	2019-07-01	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-07-01	0
Total participants	2019-07-01	147
Number of participants with account balances	2019-07-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-07-01	4

Financial Data on NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN

Measure	Date	Value
2021 : NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$0
Total income from all sources (including contributions)	2021-06-30	$57,575
Total loss/gain on sale of assets	2021-06-30	$0
Total of all expenses incurred	2021-06-30	$5,129
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-06-30	$5,129
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-06-30	$12,510
Value of total assets at end of year	2021-06-30	$527,418
Value of total assets at beginning of year	2021-06-30	$474,972
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-06-30	$0
Total interest from all sources	2021-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-06-30	No
Was this plan covered by a fidelity bond	2021-06-30	Yes
Value of fidelity bond cover	2021-06-30	$30,000
If this is an individual account plan, was there a blackout period	2021-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2021-06-30	No
Contributions received from participants	2021-06-30	$12,510
Participant contributions at beginning of year	2021-06-30	$0
Total non interest bearing cash at end of year	2021-06-30	$19,523
Total non interest bearing cash at beginning of year	2021-06-30	$19,234
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-06-30	No
Value of net income/loss	2021-06-30	$52,446
Value of net assets at end of year (total assets less liabilities)	2021-06-30	$527,418
Value of net assets at beginning of year (total assets less liabilities)	2021-06-30	$474,972
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-06-30	No
Were any leases to which the plan was party in default or uncollectible	2021-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-06-30	$91,382
Value of interest in pooled separate accounts at end of year	2021-06-30	$491,889
Value of interest in pooled separate accounts at beginning of year	2021-06-30	$348,350
Net investment gain/loss from pooled separate accounts	2021-06-30	$45,065
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-06-30	No
Was there a failure to transmit to the plan any participant contributions	2021-06-30	No
Has the plan failed to provide any benefit when due under the plan	2021-06-30	No
Employer contributions (assets) at end of year	2021-06-30	$16,006
Employer contributions (assets) at beginning of year	2021-06-30	$16,006
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-06-30	$5,129
Did the plan have assets held for investment	2021-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-06-30	No
Opinion of an independent qualified public accountant for this plan	2021-06-30	Disclaimer
Accountancy firm name	2021-06-30	CLARK, SCHAEFER, HACKETT & CO.
Accountancy firm EIN	2021-06-30	310800053
2020 : NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total income from all sources (including contributions)	2020-06-30	$22,730
Total loss/gain on sale of assets	2020-06-30	$0
Total of all expenses incurred	2020-06-30	$78,730
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$78,730
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$8,924
Value of total assets at end of year	2020-06-30	$474,972
Value of total assets at beginning of year	2020-06-30	$530,972
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$0
Total interest from all sources	2020-06-30	$-29
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	No
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$30,000
If this is an individual account plan, was there a blackout period	2020-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$8,924
Participant contributions at end of year	2020-06-30	$0
Participant contributions at beginning of year	2020-06-30	$447
Participant contributions at beginning of year	2020-06-30	$2,025
Total non interest bearing cash at end of year	2020-06-30	$19,234
Total non interest bearing cash at beginning of year	2020-06-30	$16,546
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$-56,000
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$474,972
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$530,972
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-06-30	$91,382
Value of interest in pooled separate accounts at end of year	2020-06-30	$348,350
Value of interest in pooled separate accounts at beginning of year	2020-06-30	$495,948
Interest on participant loans	2020-06-30	$-29
Net investment gain/loss from pooled separate accounts	2020-06-30	$13,835
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Employer contributions (assets) at end of year	2020-06-30	$16,006
Employer contributions (assets) at beginning of year	2020-06-30	$16,006
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$78,730
Did the plan have assets held for investment	2020-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-06-30	Disclaimer
Accountancy firm name	2020-06-30	PARMS COMPANY
Accountancy firm EIN	2020-06-30	010548473

Form 5500 Responses for NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN

2020: NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	No
2020-07-01	This submission is the final filing	No
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-07-01	Plan is a collectively bargained plan	No
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – Trust	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement - Trust	Yes
2019: NORTH COMMUNITY COUNSELING CENTERS, INC. TAX SHELTERED ANNUITY PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

1095069

Policy instance

Insurance contract or identification number	1095069
Number of Individuals Covered	18
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
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?	Yes
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

LIFE INSURANCE COMPANY OF THE SOUTHWEST (National Association of Insurance Commissioners NAIC id number: 65528 )

Policy contract number

07NDF5G8

Policy instance

Insurance contract or identification number	07NDF5G8
Number of Individuals Covered	25
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
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	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

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Company Name:	NORTH COMMUNITY COUNSELING CENTERS,
Employer identification number (EIN):	311258042
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers