401k Plan data: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS plan

CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 401k Plan overview

Plan Name	CROSSNORE SCHOOL LIFE AND DISABILITY PLANS
Plan identification number	501

CROSSNORE SCHOOL LIFE AND DISABILITY PLANS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

CROSSNORE COMMUNITIES FOR CHILDREN, INC has sponsored the creation of one or more 401k plans.

Company Name: CROSSNORE COMMUNITIES FOR CHILDREN, INC

Employer identification number (EIN): 560567980

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CROSSNORE SCHOOL LIFE AND DISABILITY PLANS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01 TERESA HUFFMAN 2020-07-31
501 2019-01-01 TERESA HUFFMAN 2021-05-18
501 2018-01-01 TERESA HUFFMAN 2019-07-29
501 2018-01-01 TERESA HUFFMAN 2020-07-30
501 2016-12-01 TERESA HUFFMAN TERESA HUFFMAN 2018-04-02
501 2016-11-30 TERESA HUFFMAN TERESA HUFFMAN 2018-04-02
501 2015-12-01 TERESA HUFFMAN TERESA HUFFMAN 2017-03-31

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01	TERESA HUFFMAN	2020-07-31
501	2019-01-01	TERESA HUFFMAN	2021-05-18
501	2018-01-01	TERESA HUFFMAN	2019-07-29
501	2018-01-01	TERESA HUFFMAN	2020-07-30
501	2016-12-01	TERESA HUFFMAN		TERESA HUFFMAN	2018-04-02
501	2016-11-30	TERESA HUFFMAN		TERESA HUFFMAN	2018-04-02
501	2015-12-01	TERESA HUFFMAN		TERESA HUFFMAN	2017-03-31

Plan Statistics for CROSSNORE SCHOOL LIFE AND DISABILITY PLANS

401k plan membership statisitcs for CROSSNORE SCHOOL LIFE AND DISABILITY PLANS

Measure Date Value
2019: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2019 401k membership
Total participants, beginning-of-year 2019-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 220
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 220
2018: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2018 401k membership
Total participants, beginning-of-year 2018-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 180
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 180
2016: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2016 401k membership
Total participants, beginning-of-year 2016-12-01 121
Total number of active participants reported on line 7a of the Form 5500 2016-12-01 126
Total of all active and inactive participants 2016-12-01 126
Total participants 2016-12-01 126
Total participants, beginning-of-year 2016-11-30 121
Total number of active participants reported on line 7a of the Form 5500 2016-11-30 126
Total of all active and inactive participants 2016-11-30 126
Total participants 2016-11-30 126
2015: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2015 401k membership
Total participants, beginning-of-year 2015-12-01 108
Total number of active participants reported on line 7a of the Form 5500 2015-12-01 121
Total of all active and inactive participants 2015-12-01 121
Total participants 2015-12-01 121

Measure	Date	Value
2019: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2019 401k membership
Total participants, beginning-of-year	2019-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	220
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	220
2018: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2018 401k membership
Total participants, beginning-of-year	2018-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	180
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	180
2016: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2016 401k membership
Total participants, beginning-of-year	2016-12-01	121
Total number of active participants reported on line 7a of the Form 5500	2016-12-01	126
Total of all active and inactive participants	2016-12-01	126
Total participants	2016-12-01	126
Total participants, beginning-of-year	2016-11-30	121
Total number of active participants reported on line 7a of the Form 5500	2016-11-30	126
Total of all active and inactive participants	2016-11-30	126
Total participants	2016-11-30	126
2015: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2015 401k membership
Total participants, beginning-of-year	2015-12-01	108
Total number of active participants reported on line 7a of the Form 5500	2015-12-01	121
Total of all active and inactive participants	2015-12-01	121
Total participants	2015-12-01	121

Form 5500 Responses for CROSSNORE SCHOOL LIFE AND DISABILITY PLANS

2019: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2016: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2016 form 5500 responses
2016-12-01	Type of plan entity	Single employer plan
2016-12-01	Submission has been amended	Yes
2016-12-01	This submission is the final filing	No
2016-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-12-01	Plan is a collectively bargained plan	No
2016-12-01	Plan funding arrangement – Insurance	Yes
2016-12-01	Plan benefit arrangement – Insurance	Yes
2016-11-30	Type of plan entity	Single employer plan
2016-11-30	Submission has been amended	No
2016-11-30	This submission is the final filing	No
2016-11-30	This return/report is a short plan year return/report (less than 12 months)	No
2016-11-30	Plan is a collectively bargained plan	No
2016-11-30	Plan funding arrangement – Insurance	Yes
2016-11-30	Plan benefit arrangement – Insurance	Yes
2015: CROSSNORE SCHOOL LIFE AND DISABILITY PLANS 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	First time form 5500 has been submitted	Yes
2015-12-01	Submission has been amended	No
2015-12-01	This submission is the final filing	No
2015-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-12-01	Plan is a collectively bargained plan	No
2015-12-01	Plan funding arrangement – Insurance	Yes
2015-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

24650

Policy instance

Insurance contract or identification number	24650
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 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	CRITICAL ILLNESS, AD&D, ACCIDENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS
Number of Individuals Covered	0
Welfare Benefit Premiums Paid to Carrier	USD $0
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

24650

Policy instance

Insurance contract or identification number	24650
Number of Individuals Covered	237
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $16,805
Total amount of fees paid to insurance company	USD $2,179
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 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	CRITICAL ILLNESS, AD&D, ACCIDENT
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 Carrier	USD $108,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,398
Insurance broker organization code?	3
Amount paid for insurance broker fees	2179
Additional information about fees paid to insurance broker	BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010181540

Policy instance

Insurance contract or identification number	000010181540
Number of Individuals Covered	121
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $807
Total amount of fees paid to insurance company	USD $357
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 Carrier	USD $4,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	187
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $0
Insurance broker name	EMPLOYEE BENEFIT ADVISORS INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010181541

Policy instance

Insurance contract or identification number	000010181541
Number of Individuals Covered	121
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $193
Total amount of fees paid to insurance company	USD $482
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $6,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	250
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $993
Insurance broker name	EMPLOYEE BENEFIT ADVISORS INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010181542

Policy instance

Insurance contract or identification number	000010181542
Number of Individuals Covered	121
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $2,898
Total amount of fees paid to insurance company	USD $1,278
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $17,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	665
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,633
Insurance broker name	EMPLOYEE BENEFIT ADVISOR INC

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Company Name:	CROSSNORE COMMUNITIES FOR CHILDREN, INC
Employer identification number (EIN):	560567980
NAIC Classification:	611000