401k Plan data: BERT NASH BENEFIT PLAN plan

BERT NASH BENEFIT PLAN 401k Plan overview

Plan Name	BERT NASH BENEFIT PLAN
Plan identification number	501

BERT NASH BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

BERT NASH COMMUNITY MENTAL HEALTH CENTER INC. has sponsored the creation of one or more 401k plans.

Company Name: BERT NASH COMMUNITY MENTAL HEALTH CENTER INC.

Employer identification number (EIN): 480775739

NAIC Classification: 621420
NAIC Description: Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BERT NASH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-06-01

Plan Statistics for BERT NASH BENEFIT PLAN

401k plan membership statisitcs for BERT NASH BENEFIT PLAN

Measure Date Value
2022: BERT NASH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 250
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 385
Number of retired or separated participants receiving benefits 2022-06-01 0
Number of other retired or separated participants entitled to future benefits 2022-06-01 0
Total of all active and inactive participants 2022-06-01 385

Measure	Date	Value
2022: BERT NASH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	250
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	385
Number of retired or separated participants receiving benefits	2022-06-01	0
Number of other retired or separated participants entitled to future benefits	2022-06-01	0
Total of all active and inactive participants	2022-06-01	385

Form 5500 Responses for BERT NASH BENEFIT PLAN

2022: BERT NASH BENEFIT PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	First time form 5500 has been submitted	Yes
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

660596758

Policy instance

Insurance contract or identification number	660596758
Number of Individuals Covered	385
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $110,445
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $110,445
Insurance broker organization code?	3

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

Policy contract number

953067

Policy instance

Insurance contract or identification number	953067
Number of Individuals Covered	291
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $12,499
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CI, HI, VOLUNTARY: AD&D
Welfare Benefit Premiums Paid to Carrier	USD $115,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,499
Insurance broker organization code?	3

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

54917-000-00001

Policy instance

Insurance contract or identification number	54917-000-00001
Number of Individuals Covered	217
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $5,599
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,599
Insurance broker organization code?	3

SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 )

Policy contract number

54917-000-00001

Policy instance

Insurance contract or identification number	54917-000-00001
Number of Individuals Covered	303
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $2,047
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,047
Insurance broker organization code?	3

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

54917-000-00002

Policy instance

Insurance contract or identification number	54917-000-00002
Number of Individuals Covered	1
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BERT NASH COMMUNITY MENTAL HEALTH CENTER INC.
Employer identification number (EIN):	480775739
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers