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CANTON REGIONAL CHAMBER HEALTH FUND 401k Plan overview

Plan NameCANTON REGIONAL CHAMBER HEALTH FUND
Plan identification number 501

CANTON REGIONAL CHAMBER HEALTH FUND Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

MILLERSBURG CLINIC, INC. has sponsored the creation of one or more 401k plans.

Company Name:MILLERSBURG CLINIC, INC.
Employer identification number (EIN):341877714
NAIC Classification:621399
NAIC Description:Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CANTON REGIONAL CHAMBER HEALTH FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-01-01BUTROS LATOUF2022-08-23 BUTROS LATOUF2022-08-23
5012020-01-01BUTROS LATOUF2021-08-12 BUTROS LATOUF
5012019-01-01BUTROS LATOUF2020-08-17 BUTROS LATOUF2020-08-17

Plan Statistics for CANTON REGIONAL CHAMBER HEALTH FUND

401k plan membership statisitcs for CANTON REGIONAL CHAMBER HEALTH FUND

Measure Date Value
2021: CANTON REGIONAL CHAMBER HEALTH FUND 2021 401k membership
Total participants, beginning-of-year2021-01-017
Total number of active participants reported on line 7a of the Form 55002021-01-010
Total of all active and inactive participants2021-01-010
2020: CANTON REGIONAL CHAMBER HEALTH FUND 2020 401k membership
Total participants, beginning-of-year2020-01-017
Total number of active participants reported on line 7a of the Form 55002020-01-017
Total of all active and inactive participants2020-01-017
2019: CANTON REGIONAL CHAMBER HEALTH FUND 2019 401k membership
Total participants, beginning-of-year2019-01-017
Total number of active participants reported on line 7a of the Form 55002019-01-017
Total of all active and inactive participants2019-01-017

Financial Data on CANTON REGIONAL CHAMBER HEALTH FUND

Measure Date Value
2021 : CANTON REGIONAL CHAMBER HEALTH FUND 2021 401k financial data
Total plan liabilities at beginning of year2021-12-31$3,175
Total income from all sources2021-12-31$0
Expenses. Total of all expenses incurred2021-12-31$8,374
Total plan assets at end of year2021-12-31$0
Total plan assets at beginning of year2021-12-31$11,549
Value of fidelity bond covering the plan2021-12-31$1,000,000
Net income (gross income less expenses)2021-12-31$-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 plan2020-12-31$4
Total plan liabilities at end of year2020-12-31$3,175
Total plan liabilities at beginning of year2020-12-31$2,590
Total income from all sources2020-12-31$30,648
Expenses. Total of all expenses incurred2020-12-31$27,929
Benefits paid (including direct rollovers)2020-12-31$119
Total plan assets at end of year2020-12-31$11,549
Total plan assets at beginning of year2020-12-31$8,241
Value of fidelity bond covering the plan2020-12-31$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$27,810
2019 : CANTON REGIONAL CHAMBER HEALTH FUND 2019 401k financial data
Transfers to/from the plan2019-12-31$-30
Total plan liabilities at end of year2019-12-31$2,590
Total plan liabilities at beginning of year2019-12-31$0
Total income from all sources2019-12-31$27,611
Expenses. Total of all expenses incurred2019-12-31$21,930
Benefits paid (including direct rollovers)2019-12-31$2,537
Total plan assets at end of year2019-12-31$8,241
Total plan assets at beginning of year2019-12-31$0
Value of fidelity bond covering the plan2019-12-31$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

Form 5500 Responses for CANTON REGIONAL CHAMBER HEALTH FUND

2021: CANTON REGIONAL CHAMBER HEALTH FUND 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01This submission is the final filingYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: CANTON REGIONAL CHAMBER HEALTH FUND 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: CANTON REGIONAL CHAMBER HEALTH FUND 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01First time form 5500 has been submittedYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MCKINLEY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77216 )
Policy contract numberHF1220
Policy instance 1
Insurance contract or identification numberHF1220
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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 numberHF1220
Policy instance 1
Insurance contract or identification numberHF1220
Number of Individuals Covered7
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $540
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $540
Insurance broker organization code?3
MCKINLEY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77216 )
Policy contract numberHF1220
Policy instance 1
Insurance contract or identification numberHF1220
Number of Individuals Covered7
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $508
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $508
Insurance broker organization code?3

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