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| Plan Name | SERV BEHAVIORAL HEALTH SYSTEM INC. VISION PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SERV BEHAVIORAL HEALTH SYSTEM INC. |
| Employer identification number (EIN): | 223560510 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2015-11-01 | PAUL MILLER | PAUL MILLER | 2016-11-30 | |
| 503 | 2014-11-01 | PAUL MILLER | |||
| 503 | 2013-11-01 | PAUL MILLER | PAUL MILLER | 2016-11-30 |
| Measure | Date | Value |
|---|---|---|
| 2015: SERV BEHAVIORAL HEALTH SYSTEM INC. VISION PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-11-01 | 283 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 0 |
| Number of retired or separated participants receiving benefits | 2015-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-11-01 | 0 |
| Total of all active and inactive participants | 2015-11-01 | 0 |
| 2014: SERV BEHAVIORAL HEALTH SYSTEM INC. VISION PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-11-01 | 228 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 279 |
| Number of retired or separated participants receiving benefits | 2014-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-11-01 | 0 |
| Total of all active and inactive participants | 2014-11-01 | 279 |
| 2013: SERV BEHAVIORAL HEALTH SYSTEM INC. VISION PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-11-01 | 203 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 249 |
| Number of retired or separated participants receiving benefits | 2013-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 0 |
| Total of all active and inactive participants | 2013-11-01 | 249 |
| 2015: SERV BEHAVIORAL HEALTH SYSTEM INC. VISION PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | Yes |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: SERV BEHAVIORAL HEALTH SYSTEM INC. VISION PLAN 2014 form 5500 responses | ||
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: SERV BEHAVIORAL HEALTH SYSTEM INC. VISION PLAN 2013 form 5500 responses | ||
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | First time form 5500 has been submitted | Yes |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 30038582 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 30038582 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 30038582 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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