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NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameNORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN
Plan identification number 501

NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Prepaid legal
  • Other welfare benefit cover
  • 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

NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. has sponsored the creation of one or more 401k plans.

Company Name:NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC.
Employer identification number (EIN):610650922
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-08-01DAVID CARROLL2023-01-17
5012017-08-01
5012017-08-01DAVID CARROLL2020-02-18
5012016-08-01
5012015-08-01
5012014-08-01
5012014-08-01
5012013-08-01

Plan Statistics for NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2021: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-01101
Total number of active participants reported on line 7a of the Form 55002021-08-01101
Total of all active and inactive participants2021-08-01101
2017: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-01127
Total number of active participants reported on line 7a of the Form 55002017-08-01125
Total of all active and inactive participants2017-08-01125
Total participants2017-08-01125
2016: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01127
Total number of active participants reported on line 7a of the Form 55002016-08-01127
Total of all active and inactive participants2016-08-01127
Total participants2016-08-01127
2015: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01112
Total number of active participants reported on line 7a of the Form 55002015-08-01114
Total of all active and inactive participants2015-08-01114
Total participants2015-08-01114
2014: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01100
Total number of active participants reported on line 7a of the Form 55002014-08-01112
Total of all active and inactive participants2014-08-01112
Total participants2014-08-01112
2013: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01105
Total number of active participants reported on line 7a of the Form 55002013-08-01100
Total of all active and inactive participants2013-08-01100
Total participants2013-08-01100

Form 5500 Responses for NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN

2021: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – InsuranceYes
2017: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Submission has been amendedYes
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – InsuranceYes
2016: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – InsuranceYes
2015: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01First time form 5500 has been submittedYes
2014-08-01Submission has been amendedYes
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: NORTHEAST KENTUCKY COMMUNITY ACTION AGENCY, INC. HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01First time form 5500 has been submittedYes
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberGL885342
Policy instance 5
Insurance contract or identification numberGL885342
Number of Individuals Covered53
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $266
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $266
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMK97027
Policy instance 4
Insurance contract or identification numberMK97027
Number of Individuals Covered101
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $825
Total amount of fees paid to insurance companyUSD $825
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $7,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $825
Insurance broker organization code?3
Amount paid for insurance broker fees825
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number569888
Policy instance 3
Insurance contract or identification number569888
Number of Individuals Covered99
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $2,366
Total amount of fees paid to insurance companyUSD $100
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,366
Amount paid for insurance broker fees100
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7203961
Policy instance 2
Insurance contract or identification numberE7203961
Number of Individuals Covered28
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $1,542
Total amount of fees paid to insurance companyUSD $65
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER, HOSPITAL, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $15,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,002
Amount paid for insurance broker fees23
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00016072
Policy instance 1
Insurance contract or identification number00016072
Number of Individuals Covered97
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $849
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $849
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00016072
Policy instance 1
Insurance contract or identification number00016072
Number of Individuals Covered95
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $872
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7203961
Policy instance 2
Insurance contract or identification numberE7203961
Number of Individuals Covered43
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $2,468
Total amount of fees paid to insurance companyUSD $166
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER, HOSPITAL, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $23,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number569888
Policy instance 3
Insurance contract or identification number569888
Number of Individuals Covered125
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $2,217
Total amount of fees paid to insurance companyUSD $184
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMK97027
Policy instance 4
Insurance contract or identification numberMK97027
Number of Individuals Covered98
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $989
Total amount of fees paid to insurance companyUSD $988
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, SUPP. AD&D, SUPP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $8,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMK97027
Policy instance 4
Insurance contract or identification numberMK97027
Number of Individuals Covered114
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $855
Total amount of fees paid to insurance companyUSD $855
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, SUPP. AD&D, SUPP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $7,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees855
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $855
Insurance broker nameGEORGE W ARNOLD
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number569888
Policy instance 3
Insurance contract or identification number569888
Number of Individuals Covered112
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $2,227
Total amount of fees paid to insurance companyUSD $111
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,227
Amount paid for insurance broker fees111
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker namePHIL BROWN INSURANCE AGENCY, INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7203961
Policy instance 2
Insurance contract or identification numberE7203961
Number of Individuals Covered45
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $2,310
Total amount of fees paid to insurance companyUSD $64
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER, HOSPITAL, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $24,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3
Insurance broker organization code?3
Amount paid for insurance broker fees1
Insurance broker nameJ SMITH LANIER & CO
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00016072
Policy instance 1
Insurance contract or identification number00016072
Number of Individuals Covered113
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $774
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $774
Insurance broker organization code?3
Insurance broker namePHIL BROWN INSURANCE AGENCY, INC.
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00016072
Policy instance 1
Insurance contract or identification number00016072
Number of Individuals Covered112
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $934
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $934
Insurance broker organization code?3
Insurance broker namePHIL BROWN INSURANCE AGENCY, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number569888
Policy instance 3
Insurance contract or identification number569888
Number of Individuals Covered111
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $2,306
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,306
Insurance broker organization code?3
Insurance broker namePHIL BROWN INSURANCE AGENCY, INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7203961
Policy instance 2
Insurance contract or identification numberE7203961
Number of Individuals Covered54
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $5,225
Total amount of fees paid to insurance companyUSD $801
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER, HOSPITAL, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $26,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6
Insurance broker organization code?3
Amount paid for insurance broker fees19
Additional information about fees paid to insurance brokerFEES
Insurance broker nameJ SMITH LANIER & CO
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMK97027
Policy instance 4
Insurance contract or identification numberMK97027
Number of Individuals Covered116
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $896
Total amount of fees paid to insurance companyUSD $896
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, SUPP. AD&D, SUPP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $8,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees896
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $896
Insurance broker nameGEORGE W ARNOLD
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMK97027
Policy instance 4
Insurance contract or identification numberMK97027
Number of Individuals Covered102
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $782
Total amount of fees paid to insurance companyUSD $782
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, SUPP. AD&D, SUPP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $7,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees782
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $782
Insurance broker nameGEORGE W ARNOLD
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number569888
Policy instance 3
Insurance contract or identification number569888
Number of Individuals Covered99
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $2,017
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,017
Insurance broker organization code?3
Insurance broker namePHIL BROWN INSURANCE AGENCY, INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7203961
Policy instance 2
Insurance contract or identification numberE7203961
Number of Individuals Covered48
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $3,294
Total amount of fees paid to insurance companyUSD $270
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER, HOSPITAL, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $21,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,949
Amount paid for insurance broker fees173
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameJ SMITH LANIER & CO
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00016072
Policy instance 1
Insurance contract or identification number00016072
Number of Individuals Covered100
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $583
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $583
Insurance broker organization code?3
Insurance broker namePHIL BROWN INSURANCE AGENCY, INC.

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