401k Plan data: LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH PLAN plan

LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH PLAN 401k Plan overview

Plan Name	LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH PLAN
Plan identification number	501

LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH 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) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS has sponsored the creation of one or more 401k plans.

Company Name: LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS

Employer identification number (EIN): 824226492

NAIC Classification: 621330
NAIC Description: Offices of Mental Health Practitioners (except Physicians)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 CHRYSTAL ZIMMERMAN 2024-10-02
501 2022-01-01 JULIE COTTRELL 2023-04-03
501 2021-01-01 MICHELLE PARSONS 2022-10-11
501 2021-01-01 JULIE COTTRELL 2023-04-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	CHRYSTAL ZIMMERMAN	2024-10-02
501	2022-01-01	JULIE COTTRELL	2023-04-03
501	2021-01-01	MICHELLE PARSONS	2022-10-11
501	2021-01-01	JULIE COTTRELL	2023-04-13

Form 5500 Responses for LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH PLAN

2023: LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS GROUP HEALTH PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0C893

Policy instance

Insurance contract or identification number	GLUG0C893
Number of Individuals Covered	313
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $13,070
Total amount of fees paid to insurance company	USD $11,977
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $126,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10327441001

Policy instance

Insurance contract or identification number	10327441001
Number of Individuals Covered	234
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,264
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 )

Policy contract number

85487

Policy instance

Insurance contract or identification number	85487
Number of Individuals Covered	229
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,057
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

920180

Policy instance

Insurance contract or identification number	920180
Number of Individuals Covered	134
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $29,621
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00621252

Policy instance

Insurance contract or identification number	G00621252
Number of Individuals Covered	260
Insurance policy start date	2022-01-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $9,055
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $61,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10327441001

Policy instance

Insurance contract or identification number	10327441001
Number of Individuals Covered	182
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $579
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 )

Policy contract number

85487

Policy instance

Insurance contract or identification number	85487
Number of Individuals Covered	188
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,209
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

920180

Policy instance

Insurance contract or identification number	920180
Number of Individuals Covered	260
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $42,742
Total amount of fees paid to insurance company	USD $1,554
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00621252

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10327441001

Policy instance

DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 )

Policy contract number

85487

Policy instance

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

920180

Policy instance

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Company Name:	LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS
Employer identification number (EIN):	824226492
NAIC Classification:	621330
NAIC Description:	Offices of Mental Health Practitioners (except Physicians)