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CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 401k Plan overview

Plan NameCONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN
Plan identification number 507

CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Other welfare benefit cover

401k Sponsoring company profile

CONGRESSIONAL COUNTRY CLUB, INC. has sponsored the creation of one or more 401k plans.

Company Name:CONGRESSIONAL COUNTRY CLUB, INC.
Employer identification number (EIN):530050980
NAIC Classification:713900

Additional information about CONGRESSIONAL COUNTRY CLUB, INC.

Jurisdiction of Incorporation: Maryland Secretary of State
Incorporation Date:
Company Identification Number: D00074591

More information about CONGRESSIONAL COUNTRY CLUB, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072017-01-01
5072016-01-01
5072015-01-01JEFFREY KREAFLE
5072014-01-01DEAN DAVIDSON
5072013-01-01DEAN DAVIDSON
5072012-01-01DEAN DAVIDSON
5072011-01-01MICHAEL LEEMHUIS
5072010-01-01DEAN DAVIDSON
5072009-01-01DEAN DAVIDSON

Plan Statistics for CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN

401k plan membership statisitcs for CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN

Measure Date Value
2017: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01202
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
2016: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01227
Total number of active participants reported on line 7a of the Form 55002016-01-01202
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01202
2015: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01217
Total number of active participants reported on line 7a of the Form 55002015-01-01224
Number of retired or separated participants receiving benefits2015-01-013
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01227
2014: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01232
Total number of active participants reported on line 7a of the Form 55002014-01-01214
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01214
2013: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01211
Total number of active participants reported on line 7a of the Form 55002013-01-01224
Number of retired or separated participants receiving benefits2013-01-011
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01225
2012: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01207
Total number of active participants reported on line 7a of the Form 55002012-01-01208
Number of retired or separated participants receiving benefits2012-01-013
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01211
2011: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01202
Total number of active participants reported on line 7a of the Form 55002011-01-01206
Number of retired or separated participants receiving benefits2011-01-012
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01208
2010: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01205
Total number of active participants reported on line 7a of the Form 55002010-01-01201
Number of retired or separated participants receiving benefits2010-01-012
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01203
2009: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01197
Total number of active participants reported on line 7a of the Form 55002009-01-01199
Number of retired or separated participants receiving benefits2009-01-012
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01201

Form 5500 Responses for CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN

2017: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01This submission is the final filingYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: CONGRESSIONAL COUNTRY CLUB INC MEDICAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number0LTV
Policy instance 1
Insurance contract or identification number0LTV
Number of Individuals Covered383
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $65,883
Total amount of fees paid to insurance companyUSD $40,358
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,125,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,475
Amount paid for insurance broker fees17283
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS X PCPM NON-MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameBENEFITMALL
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number0LTV
Policy instance 1
Insurance contract or identification number0LTV
Number of Individuals Covered219
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $74,079
Total amount of fees paid to insurance companyUSD $13,230
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $2,116,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74,079
Amount paid for insurance broker fees13230
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS AND NON-MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameAARON C DAVIS/NEXTLOGICAL
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number0LTV
Policy instance 1
Insurance contract or identification number0LTV
Number of Individuals Covered218
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $68,877
Total amount of fees paid to insurance companyUSD $1,911
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $1,967,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,877
Amount paid for insurance broker fees1911
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS AND NON-MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameAARON C DAVIS/NEXTLOGICAL
CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )
Policy contract number0LTV
Policy instance 1
Insurance contract or identification number0LTV
Number of Individuals Covered224
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $54,428
Total amount of fees paid to insurance companyUSD $18,308
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $1,555,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,428
Amount paid for insurance broker fees18308
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS DENTAL CONTRACTS AND NON-MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameAARON C DAVIS/NEXTLOGICAL
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number0LTV
Policy instance 1
Insurance contract or identification number0LTV
Number of Individuals Covered204
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $56,537
Total amount of fees paid to insurance companyUSD $21,414
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $1,615,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,537
Amount paid for insurance broker fees21414
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS DENTAL CONTRACTS AND NON-MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameAARON DAVIS
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number0LTV
Policy instance 1
Insurance contract or identification number0LTV
Number of Individuals Covered208
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $68,134
Total amount of fees paid to insurance companyUSD $17,964
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $1,816,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number0LTV
Policy instance 1
Insurance contract or identification number0LTV
Number of Individuals Covered203
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $77,751
Total amount of fees paid to insurance companyUSD $21,455
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $2,073,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $77,751
Amount paid for insurance broker fees21455
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS DENTAL CONTRACTS AND NON-MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameAARON DAVIS

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