401k Plan data: CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN plan

CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN
Plan identification number	501

CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Vision
Temporary disability (accident and sickness)
Long-term disability cover
Death benefits (include travel accident but not life insurance)
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

CHURCH COMMUNITY BUILDER, INC. has sponsored the creation of one or more 401k plans.

Company Name: CHURCH COMMUNITY BUILDER, INC.

Employer identification number (EIN): 421538063

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Additional information about CHURCH COMMUNITY BUILDER, INC.

Jurisdiction of Incorporation: Colorado Department of State

Incorporation Date: 2002-04-29

Company Identification Number: 20021111692

Legal Registered Office Address: 10807 New Allegiance Dr.
Ste 300
Colorado Springs
United States of America (USA)
80921

More information about CHURCH COMMUNITY BUILDER, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-07-01
501 2017-07-01 DON HARMS 2019-08-12
501 2016-07-01

Plan Statistics for CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN

Measure Date Value
2017: CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 119
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 102
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 0
Total of all active and inactive participants 2017-07-01 102
Number of employers contributing to the scheme 2017-07-01 0
2016: CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 104
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 94
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 94

Measure	Date	Value
2017: CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	119
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	102
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	102
Number of employers contributing to the scheme	2017-07-01	0
2016: CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	104
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	94
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	94

Form 5500 Responses for CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN

2017: CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	Yes
2017-07-01	This submission is the final filing	Yes
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: CHURCH COMMUNITY BUILDER EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

803662

Policy instance

Insurance contract or identification number	803662
Number of Individuals Covered	225
Insurance policy start date	2017-07-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $39,864
Total amount of fees paid to insurance company	USD $88
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $795,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $39,864
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker name	HUB INTERNATIONAL INS. SVCES., INC.

ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )

Policy contract number

867513

Policy instance

Insurance contract or identification number	867513
Number of Individuals Covered	82
Insurance policy start date	2017-07-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $12,971
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $129,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $12,971
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL INS. SVCES., INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30048739

Policy instance

Insurance contract or identification number	30048739
Number of Individuals Covered	75
Insurance policy start date	2017-07-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $745
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $745
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL INS. SVCES., INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

151906

Policy instance

Insurance contract or identification number	151906
Number of Individuals Covered	102
Insurance policy start date	2017-07-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $8,541
Total amount of fees paid to insurance company	USD $1,527
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,541
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker name	HUB INTERNATIONAL INS. SVCES., INC.

Potentially related plans

CHURCH COMMUNITY SERVICES, INC 401(K) PLAN [EIN = 351155054]

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Company Name:	CHURCH COMMUNITY BUILDER, INC.
Employer identification number (EIN):	421538063
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services

Jurisdiction of Incorporation:	Colorado Department of State
Incorporation Date:	2002-04-29
Company Identification Number:	20021111692
Legal Registered Office Address:	10807 New Allegiance Dr. Ste 300 Colorado Springs United States of America (USA) 80921