MILLERSBURG CLINIC, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CANTON REGIONAL CHAMBER HEALTH FUND
| Measure | Date | Value |
|---|
| 2021: CANTON REGIONAL CHAMBER HEALTH FUND 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 0 |
| 2020: CANTON REGIONAL CHAMBER HEALTH FUND 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 7 |
| Total of all active and inactive participants | 2020-01-01 | 7 |
| 2019: CANTON REGIONAL CHAMBER HEALTH FUND 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 7 |
| Total of all active and inactive participants | 2019-01-01 | 7 |
| Measure | Date | Value |
|---|
| 2021 : CANTON REGIONAL CHAMBER HEALTH FUND 2021 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2021-12-31 | $3,175 |
| Total income from all sources | 2021-12-31 | $0 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $8,374 |
| Total plan assets at end of year | 2021-12-31 | $0 |
| Total plan assets at beginning of year | 2021-12-31 | $11,549 |
| Value of fidelity bond covering the plan | 2021-12-31 | $1,000,000 |
| Net income (gross income less expenses) | 2021-12-31 | $-8,374 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $8,374 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $8,374 |
| 2020 : CANTON REGIONAL CHAMBER HEALTH FUND 2020 401k financial data |
|---|
| Transfers to/from the plan | 2020-12-31 | $4 |
| Total plan liabilities at end of year | 2020-12-31 | $3,175 |
| Total plan liabilities at beginning of year | 2020-12-31 | $2,590 |
| Total income from all sources | 2020-12-31 | $30,648 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $27,929 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $119 |
| Total plan assets at end of year | 2020-12-31 | $11,549 |
| Total plan assets at beginning of year | 2020-12-31 | $8,241 |
| Value of fidelity bond covering the plan | 2020-12-31 | $1,000,000 |
| Net income (gross income less expenses) | 2020-12-31 | $2,719 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $8,374 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $5,651 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $30,648 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $27,810 |
| 2019 : CANTON REGIONAL CHAMBER HEALTH FUND 2019 401k financial data |
|---|
| Transfers to/from the plan | 2019-12-31 | $-30 |
| Total plan liabilities at end of year | 2019-12-31 | $2,590 |
| Total plan liabilities at beginning of year | 2019-12-31 | $0 |
| Total income from all sources | 2019-12-31 | $27,611 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $21,930 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $2,537 |
| Total plan assets at end of year | 2019-12-31 | $8,241 |
| Total plan assets at beginning of year | 2019-12-31 | $0 |
| Value of fidelity bond covering the plan | 2019-12-31 | $1,000,000 |
| Net income (gross income less expenses) | 2019-12-31 | $5,681 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $5,651 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $27,611 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $19,393 |
| 2021: CANTON REGIONAL CHAMBER HEALTH FUND 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: CANTON REGIONAL CHAMBER HEALTH FUND 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: CANTON REGIONAL CHAMBER HEALTH FUND 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | First time form 5500 has been submitted | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| MCKINLEY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77216 ) |
| Policy contract number | HF1220 |
| Policy instance | 1 |
| Insurance contract or identification number | HF1220 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| MCKINLEY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77216 ) |
| Policy contract number | HF1220 |
| Policy instance | 1 |
| Insurance contract or identification number | HF1220 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $540 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $540 | | Insurance broker organization code? | 3 |
|
| MCKINLEY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77216 ) |
| Policy contract number | HF1220 |
| Policy instance | 1 |
| Insurance contract or identification number | HF1220 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $508 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,611 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $508 | | Insurance broker organization code? | 3 |
|
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