401k Plan data: RELIEVUS HEALTH AND WELFARE PLAN plan

RELIEVUS HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	RELIEVUS HEALTH AND WELFARE PLAN
Plan identification number	501

RELIEVUS HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision 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.

401k Sponsoring company profile

ADVANCED SPINE & PAIN, LLC has sponsored the creation of one or more 401k plans.

Company Name: ADVANCED SPINE & PAIN, LLC

Employer identification number (EIN): 262043323

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RELIEVUS HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-12-01 ANDREW THOMPSON 2023-09-13 ANDREW THOMPSON 2023-09-13
501 2021-12-01 ANDREW THOMPSON 2023-08-02 ANDREW THOMPSON 2023-08-02
501 2020-12-01 RON SALTIEL 2022-05-10
501 2019-12-01 RON SALTIEL 2021-08-12
501 2018-12-01 RON SALTIEL 2020-04-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-12-01	ANDREW THOMPSON	2023-09-13	ANDREW THOMPSON	2023-09-13
501	2021-12-01	ANDREW THOMPSON	2023-08-02	ANDREW THOMPSON	2023-08-02
501	2020-12-01	RON SALTIEL	2022-05-10
501	2019-12-01	RON SALTIEL	2021-08-12
501	2018-12-01	RON SALTIEL	2020-04-09

Form 5500 Responses for RELIEVUS HEALTH AND WELFARE PLAN

2022: RELIEVUS HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-12-01	Type of plan entity	Single employer plan
2022-12-01	Submission has been amended	No
2022-12-01	This submission is the final filing	Yes
2022-12-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-12-01	Plan is a collectively bargained plan	No
2022-12-01	Plan funding arrangement – Insurance	Yes
2022-12-01	Plan benefit arrangement – Insurance	Yes
2021: RELIEVUS HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	Submission has been amended	No
2021-12-01	This submission is the final filing	No
2021-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-12-01	Plan is a collectively bargained plan	No
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2020: RELIEVUS HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-12-01	Type of plan entity	Single employer plan
2020-12-01	Plan funding arrangement – Insurance	Yes
2020-12-01	Plan benefit arrangement – Insurance	Yes
2019: RELIEVUS HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-12-01	Type of plan entity	Single employer plan
2019-12-01	Plan funding arrangement – Insurance	Yes
2019-12-01	Plan benefit arrangement – Insurance	Yes
2018: RELIEVUS HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-12-01	Type of plan entity	Single employer plan
2018-12-01	First time form 5500 has been submitted	Yes
2018-12-01	Plan funding arrangement – Insurance	Yes
2018-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

801Y9

Policy instance

Insurance contract or identification number	801Y9
Number of Individuals Covered	0
Insurance policy start date	2022-12-31
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,503
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	Yes
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	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 $144,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

801Y9

Policy instance

Insurance contract or identification number	801Y9
Number of Individuals Covered	0
Insurance policy start date	2022-12-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $471
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
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 $5,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

801Y9

Policy instance

Insurance contract or identification number	801Y9
Number of Individuals Covered	0
Insurance policy start date	2022-12-01
Insurance policy end date	2022-12-31
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	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
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 $728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

801Y9

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

801Y9

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

801Y9

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

801Y9

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

801Y9

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

801Y9

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

801Y9

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

801Y9

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

801Y9

Policy instance

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Company Name:	ADVANCED SPINE & PAIN, LLC
Employer identification number (EIN):	262043323
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners