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| Plan Name | SUMMIT BEHAVIORAL SERVICES |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SUMMIT BEHAVIORAL SERVICES LLC |
| Employer identification number (EIN): | 271176682 |
| NAIC Classification: | 621330 |
| NAIC Description: | Offices of Mental Health Practitioners (except Physicians) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-05-01 | MALLORY FOLTZ | 2024-10-30 | ||
| 501 | 2022-05-01 | MALLORY FOLTZ | 2023-09-18 | ||
| 501 | 2021-05-01 | MALLORY FOLTZ | 2022-08-01 |
| Measure | Date | Value |
|---|---|---|
| 2023: SUMMIT BEHAVIORAL SERVICES 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-05-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-05-01 | 152 |
| Number of retired or separated participants receiving benefits | 2023-05-01 | 1 |
| Total of all active and inactive participants | 2023-05-01 | 153 |
| 2022: SUMMIT BEHAVIORAL SERVICES 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-05-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 129 |
| Total of all active and inactive participants | 2022-05-01 | 129 |
| 2021: SUMMIT BEHAVIORAL SERVICES 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-05-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 113 |
| Total of all active and inactive participants | 2021-05-01 | 113 |
| 2023: SUMMIT BEHAVIORAL SERVICES 2023 form 5500 responses | ||
|---|---|---|
| 2023-05-01 | Type of plan entity | Single employer plan |
| 2023-05-01 | Submission has been amended | No |
| 2023-05-01 | This submission is the final filing | No |
| 2023-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-05-01 | Plan is a collectively bargained plan | No |
| 2023-05-01 | Plan funding arrangement – Insurance | Yes |
| 2023-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: SUMMIT BEHAVIORAL SERVICES 2022 form 5500 responses | ||
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Submission has been amended | No |
| 2022-05-01 | This submission is the final filing | No |
| 2022-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-05-01 | Plan is a collectively bargained plan | No |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: SUMMIT BEHAVIORAL SERVICES 2021 form 5500 responses | ||
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | Submission has been amended | No |
| 2021-05-01 | This submission is the final filing | No |
| 2021-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-05-01 | Plan is a collectively bargained plan | No |
| 2021-05-01 | Plan funding arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 600055 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLTD0BWKM | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 600055 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLTD0BWKM | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 600055 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLTD0BWKM | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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