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| Plan Name | CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CHICAGO COMMONS |
| Employer identification number (EIN): | 362169136 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-07-01 | ASSURANCEAGENCYTPA76812 | |||
| 501 | 2022-07-01 | ||||
| 501 | 2022-07-01 | DANA THOMAS | |||
| 501 | 2021-07-01 | ||||
| 501 | 2021-07-01 | CHICAGO COMMONS | |||
| 501 | 2020-07-01 | ||||
| 501 | 2020-07-01 | ||||
| 501 | 2019-07-01 | ||||
| 501 | 2019-07-01 | ||||
| 501 | 2019-07-01 | ||||
| 501 | 2018-07-01 | ||||
| 501 | 2017-07-01 | DOTTIE JOHNSON | |||
| 501 | 2016-07-01 | DOTTIE JOHNSON | |||
| 501 | 2015-07-01 | DOTTIE JOHNSON | |||
| 501 | 2014-07-01 | DOTTIE JOHNSON | |||
| 501 | 2013-07-01 | DHIREN SHAH, CFO | DOTTIE JOHNSON, CONTROLLER | 2015-01-30 | |
| 501 | 2012-07-01 | CASSANDRA WRIGHT | CASSANDRA WRIGHT | 2014-02-07 | |
| 501 | 2011-07-01 | CASSANDRA WRIGHT | |||
| 501 | 2010-07-01 | CASSANDRA WRIGHT | |||
| 501 | 2009-07-01 | CASSANDRA WRIGHT | |||
| 501 | 2008-07-01 | CHRIS NORDLOH | 2010-05-13 |
| 2022: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | Submission has been amended | No |
| 2022-07-01 | This submission is the final filing | No |
| 2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-07-01 | Plan is a collectively bargained plan | No |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2021 form 5500 responses | ||
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Submission has been amended | No |
| 2021-07-01 | This submission is the final filing | No |
| 2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-07-01 | Plan is a collectively bargained plan | No |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE 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 – General assets of the sponsor | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE 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 benefit arrangement – Insurance | Yes |
| 2018: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2018 form 5500 responses | ||
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Submission has been amended | No |
| 2018-07-01 | This submission is the final filing | No |
| 2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-07-01 | Plan is a collectively bargained plan | No |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2017 form 5500 responses | ||
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Submission has been amended | No |
| 2017-07-01 | This submission is the final filing | No |
| 2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-07-01 | Plan is a collectively bargained plan | No |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2016 form 5500 responses | ||
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Submission has been amended | No |
| 2016-07-01 | This submission is the final filing | No |
| 2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-07-01 | Plan is a collectively bargained plan | No |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 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: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 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: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2013 form 5500 responses | ||
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2012 form 5500 responses | ||
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | Yes |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2011 form 5500 responses | ||
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2010 form 5500 responses | ||
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2009 form 5500 responses | ||
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: CHICAGO COMMONS ASSOCIATION GROUP HEALTH INSURANCE PLAN 2008 form 5500 responses | ||
| 2008-07-01 | Type of plan entity | Single employer plan |
| 2008-07-01 | Submission has been amended | No |
| 2008-07-01 | This submission is the final filing | No |
| 2008-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-07-01 | Plan is a collectively bargained plan | No |
| 2008-07-01 | Plan funding arrangement – Insurance | Yes |
| 2008-07-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5977995 |
| Policy instance | 6 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 270326 |
| Policy instance | 1 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | F020631 |
| Policy instance | 2 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5977995 |
| Policy instance | 3 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0234214 |
| Policy instance | 4 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0234515 |
| Policy instance | 5 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | F020631 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) | |
| Policy contract number | 30076268 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 270326 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 270326 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) | |
| Policy contract number | 30076268 |
| Policy instance | 2 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | F020631 |
| Policy instance | 3 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 270326 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) | |
| Policy contract number | 30076268 |
| Policy instance | 3 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | F020631 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 270326 |
| Policy instance | 1 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | F020631 |
| Policy instance | 2 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00539890 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) | |
| Policy contract number | 30076268 |
| Policy instance | 4 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) | |
| Policy contract number | 30076268 |
| Policy instance | 5 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 305141 |
| Policy instance | 4 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00539890 |
| Policy instance | 3 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | F020631 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | B49918 P75952 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | B49918 P75952 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 876284G |
| Policy instance | 2 |
| HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) | |
| Policy contract number | 744636 |
| Policy instance | 3 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | B49918 P75952 |
| Policy instance | 1 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00438350 |
| Policy instance | 2 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3160835 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | B49918 |
| Policy instance | 3 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00438350 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | B49918 |
| Policy instance | 3 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00438350 |
| Policy instance | 1 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3260835 |
| Policy instance | 2 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00438350 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | B49918 |
| Policy instance | 3 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3160835 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | B49918 |
| Policy instance | 3 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00438350 |
| Policy instance | 1 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3160835 |
| Policy instance | 2 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00438350 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | B49918 |
| Policy instance | 3 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3160835 |
| Policy instance | 2 |
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