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DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameDELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN
Plan identification number 501

DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

DELPHI BEHAVIORAL HEALTH GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name:DELPHI BEHAVIORAL HEALTH GROUP, LLC
Employer identification number (EIN):810762076
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01ANDREA LEWIS2022-12-20
5012020-07-01SAMUEL WINIKOFF2021-12-10
5012019-07-01MARIE POLAMINO2021-01-22
5012018-07-01MARIE PALOMINO2020-04-14

Plan Statistics for DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN

401k plan membership statisitcs for DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN

Measure Date Value
2021: DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01490
Total number of active participants reported on line 7a of the Form 55002021-07-01370
Number of retired or separated participants receiving benefits2021-07-016
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01376
Number of employers contributing to the scheme2021-07-010
2020: DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01343
Total number of active participants reported on line 7a of the Form 55002020-07-01471
Number of retired or separated participants receiving benefits2020-07-0119
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01490
Number of employers contributing to the scheme2020-07-010
2019: DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01325
Total number of active participants reported on line 7a of the Form 55002019-07-01328
Number of retired or separated participants receiving benefits2019-07-0115
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01343
Number of employers contributing to the scheme2019-07-010
2018: DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01301
Total number of active participants reported on line 7a of the Form 55002018-07-01325
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01325
Number of employers contributing to the scheme2018-07-010

Form 5500 Responses for DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN

2021: DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: DELPHI BEHAVIORAL HEALTH GROUP HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01First time form 5500 has been submittedYes
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914710
Policy instance 1
Insurance contract or identification number914710
Number of Individuals Covered294
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,164
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees2164
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )
Policy contract number169384HNO
Policy instance 2
Insurance contract or identification number169384HNO
Number of Individuals Covered157
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $41,213
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $780,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees41213
Additional information about fees paid to insurance brokerDIRECT COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number169384
Policy instance 3
Insurance contract or identification number169384
Number of Individuals Covered370
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $34,847
Total amount of fees paid to insurance companyUSD $68,368
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $1,306,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $17,745
Amount paid for insurance broker fees68368
Additional information about fees paid to insurance brokerINCENTIVE RISK, INDIRECT COMPENSATION, DIRECT COMPENSATION
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX969518
Policy instance 4
Insurance contract or identification numberFLX969518
Number of Individuals Covered370
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $10,295
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $102,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $10,295
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914710
Policy instance 1
Insurance contract or identification number914710
Number of Individuals Covered380
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,267
Total amount of fees paid to insurance companyUSD $10,729
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $224,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,267
Amount paid for insurance broker fees10729
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number169384
Policy instance 2
Insurance contract or identification number169384
Number of Individuals Covered492
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $23,111
Total amount of fees paid to insurance companyUSD $18,908
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,367,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $23,111
Amount paid for insurance broker fees17856
Additional information about fees paid to insurance broker2020 PINNACLE SPECIALTY NEW BUSINESS INCENTIVE RISK 2020 PINNACLE MEDICAL NEW BUSINESS INCENTIVE RISK
Insurance broker organization code?3
AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )
Policy contract number169384HNO
Policy instance 3
Insurance contract or identification number169384HNO
Number of Individuals Covered218
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $947,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914710
Policy instance 1
Insurance contract or identification number914710
Number of Individuals Covered502
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $22,190
Total amount of fees paid to insurance companyUSD $135,518
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,676,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,190
Amount paid for insurance broker fees135518
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT BONUS
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914710
Policy instance 1
Insurance contract or identification number914710
Number of Individuals Covered763
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $12,363
Total amount of fees paid to insurance companyUSD $70,809
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,615,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,363
Amount paid for insurance broker fees70809
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3

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