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COMMUNITY BASED CARE, LLC ANCILLARY PLAN 401k Plan overview

Plan NameCOMMUNITY BASED CARE, LLC ANCILLARY PLAN
Plan identification number 502

COMMUNITY BASED CARE, LLC ANCILLARY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

COMMUNITY BASED CARE, LLC has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY BASED CARE, LLC
Employer identification number (EIN):474471803
NAIC Classification:561490

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY BASED CARE, LLC ANCILLARY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022018-02-01

Plan Statistics for COMMUNITY BASED CARE, LLC ANCILLARY PLAN

401k plan membership statisitcs for COMMUNITY BASED CARE, LLC ANCILLARY PLAN

Measure Date Value
2018: COMMUNITY BASED CARE, LLC ANCILLARY PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01477
Total number of active participants reported on line 7a of the Form 55002018-02-010
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-010

Form 5500 Responses for COMMUNITY BASED CARE, LLC ANCILLARY PLAN

2018: COMMUNITY BASED CARE, LLC ANCILLARY PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01First time form 5500 has been submittedYes
2018-02-01Submission has been amendedNo
2018-02-01This submission is the final filingYes
2018-02-01This return/report is a short plan year return/report (less than 12 months)No
2018-02-01Plan is a collectively bargained planNo
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00529482
Policy instance 1
Insurance contract or identification number00529482
Number of Individuals Covered477
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $43,727
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, VOLUNTARY CRITICAL ILLNESS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $349,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,255
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3

Potentially related plans

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