401k Plan data: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN plan

BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN
Plan identification number	001

BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BEHAVIORAL SERVICES OF TN, INC. has sponsored the creation of one or more 401k plans.

Company Name: BEHAVIORAL SERVICES OF TN, INC.

Employer identification number (EIN): 582595230

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 CYNTHIA ZELLER-GONZALEZ CYNTHIA ZELLER-GONZALEZ 2013-10-11
001 2011-01-01 CYNTHIA ZELLER-GONZALEZ 2012-10-10 CYNTHIA ZELLER-GONZALEZ 2012-10-10
001 2010-01-01 CYNTHIA M. ZELLER-GONZALEZ 2011-03-24 CYNTHIA M. ZELLER-GONZALEZ 2011-03-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01
001	2015-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	CYNTHIA ZELLER-GONZALEZ		CYNTHIA ZELLER-GONZALEZ	2013-10-11
001	2011-01-01	CYNTHIA ZELLER-GONZALEZ	2012-10-10	CYNTHIA ZELLER-GONZALEZ	2012-10-10
001	2010-01-01	CYNTHIA M. ZELLER-GONZALEZ	2011-03-24	CYNTHIA M. ZELLER-GONZALEZ	2011-03-24

Plan Statistics for BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN

Measure Date Value
2015: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 109
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 16
Total of all active and inactive participants 2015-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 125
Number of participants with account balances 2015-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 115
Number of other retired or separated participants entitled to future benefits 2014-01-01 13
Total of all active and inactive participants 2014-01-01 128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 128
Number of participants with account balances 2014-01-01 29
2013: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 136
Number of other retired or separated participants entitled to future benefits 2013-01-01 11
Total of all active and inactive participants 2013-01-01 147
Total participants 2013-01-01 147
Number of participants with account balances 2013-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 112
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 11
Total of all active and inactive participants 2012-01-01 123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 123
Number of participants with account balances 2012-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2015: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	109
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	16
Total of all active and inactive participants	2015-01-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	125
Number of participants with account balances	2015-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	115
Number of other retired or separated participants entitled to future benefits	2014-01-01	13
Total of all active and inactive participants	2014-01-01	128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	128
Number of participants with account balances	2014-01-01	29
2013: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	136
Number of other retired or separated participants entitled to future benefits	2013-01-01	11
Total of all active and inactive participants	2013-01-01	147
Total participants	2013-01-01	147
Number of participants with account balances	2013-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	112
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	11
Total of all active and inactive participants	2012-01-01	123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	123
Number of participants with account balances	2012-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2015 : BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$29,282
Total of all expenses incurred	2015-12-31	$84,293
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$80,745
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$58,007
Value of total assets at end of year	2015-12-31	$873,996
Value of total assets at beginning of year	2015-12-31	$929,007
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$3,548
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$100,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$36,332
Total non interest bearing cash at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-55,011
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$873,996
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$929,007
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$873,996
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$929,007
Net investment gain/loss from pooled separate accounts	2015-12-31	$-28,725
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$21,675
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$80,745
Contract administrator fees	2015-12-31	$3,548
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	HORNE, LLP
Accountancy firm EIN	2015-12-31	201941244
2014 : BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$173,166
Total of all expenses incurred	2014-12-31	$6,414
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,983
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$130,425
Value of total assets at end of year	2014-12-31	$929,007
Value of total assets at beginning of year	2014-12-31	$762,255
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$3,431
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$100,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$82,759
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$1,933
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$166,752
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$929,007
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$762,255
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$929,007
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$760,322
Net investment gain/loss from pooled separate accounts	2014-12-31	$42,741
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$47,666
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,983
Contract administrator fees	2014-12-31	$3,431
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	HORNE, LLP
Accountancy firm EIN	2014-12-31	201941244
2013 : BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$227,376
Total of all expenses incurred	2013-12-31	$11,035
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$8,211
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$122,862
Value of total assets at end of year	2013-12-31	$762,255
Value of total assets at beginning of year	2013-12-31	$545,914
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$2,824
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$100,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$73,011
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$138
Total non interest bearing cash at end of year	2013-12-31	$1,933
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$216,341
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$762,255
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$545,914
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$760,322
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$545,914
Net investment gain/loss from pooled separate accounts	2013-12-31	$104,514
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$49,713
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$8,211
Contract administrator fees	2013-12-31	$2,824
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	HORNE, LLP
Accountancy firm EIN	2013-12-31	201941244
2012 : BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$181,844
Total of all expenses incurred	2012-12-31	$12,436
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$10,201
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$127,178
Value of total assets at end of year	2012-12-31	$545,914
Value of total assets at beginning of year	2012-12-31	$376,506
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$2,235
Total interest from all sources	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$50,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$67,274
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$169,408
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$545,914
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$376,506
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$545,914
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$376,506
Interest earned on other investments	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$54,666
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$59,904
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$10,201
Contract administrator fees	2012-12-31	$2,235
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	HORNE, LLP
Accountancy firm EIN	2012-12-31	201941244

Form 5500 Responses for BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN

2015: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: BEHAVIORAL SERVICES OF TENNESSEE 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

101751

Policy instance

Insurance contract or identification number	101751
Number of Individuals Covered	26
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,416
Total amount of fees paid to insurance company	USD $1,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,416
Insurance broker organization code?	3
Amount paid for insurance broker fees	900
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	BURLEIGH CONSULTING GROUP, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

101751

Policy instance

Insurance contract or identification number	101751
Number of Individuals Covered	29
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,031
Total amount of fees paid to insurance company	USD $1,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,031
Insurance broker organization code?	3
Amount paid for insurance broker fees	854
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	BURLEIGH CONSULTING GROUP, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

101751

Policy instance

Insurance contract or identification number	101751
Number of Individuals Covered	29
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,779
Total amount of fees paid to insurance company	USD $965
Commission paid to Insurance Broker	USD $3,779
Insurance broker organization code?	3
Amount paid for insurance broker fees	649
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	BURLEIGH CONSULTING GROUP, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

101751

Policy instance

Insurance contract or identification number	101751
Number of Individuals Covered	29
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,382
Total amount of fees paid to insurance company	USD $1,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,382
Insurance broker organization code?	3
Amount paid for insurance broker fees	469
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	BURLEIGH CONSULTING GROUP, INC.

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Company Name:	BEHAVIORAL SERVICES OF TN, INC.
Employer identification number (EIN):	582595230
NAIC Classification:	624100
NAIC Description:	Individual and Family Services