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| Plan Name | ARK BEHAVIORAL HEALTH EMPLOYEE BENEFIT PLAN TRUST |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ARK NATIONAL HOLDINGS LLC (D/B/A ARK BEHAVIORAL) |
| Employer identification number (EIN): | 832215221 |
| NAIC Classification: | 621420 |
| NAIC Description: | Outpatient Mental Health and Substance Abuse Centers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2021-06-01 |
| Measure | Date | Value |
|---|---|---|
| 2021: ARK BEHAVIORAL HEALTH EMPLOYEE BENEFIT PLAN TRUST 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-06-01 | 307 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 433 |
| Number of retired or separated participants receiving benefits | 2021-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-06-01 | 0 |
| Total of all active and inactive participants | 2021-06-01 | 433 |
| 2021: ARK BEHAVIORAL HEALTH EMPLOYEE BENEFIT PLAN TRUST 2021 form 5500 responses | ||
|---|---|---|
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | First time form 5500 has been submitted | Yes |
| 2021-06-01 | Submission has been amended | No |
| 2021-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-06-01 | Plan is a collectively bargained plan | No |
| 2021-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) | |||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 43592 | ||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||
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| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) | |||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 447471 | ||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 715584 | ||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||
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