401k Plan data: PROFESSIONAL CARE SERVICES OF WEST TN, INC. plan

PROFESSIONAL CARE SERVICES OF WEST TN, INC. 401k Plan overview

Plan Name	PROFESSIONAL CARE SERVICES OF WEST TN, INC.
Plan identification number	501

PROFESSIONAL CARE SERVICES OF WEST TN, INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: PROFESSIONAL CARE SERVICES OF WEST TN, INC.

Employer identification number (EIN): 621097170

NAIC Classification: 621420
NAIC Description: Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PROFESSIONAL CARE SERVICES OF WEST TN, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-02-01
501 2021-02-01

Plan Statistics for PROFESSIONAL CARE SERVICES OF WEST TN, INC.

401k plan membership statisitcs for PROFESSIONAL CARE SERVICES OF WEST TN, INC.

Measure Date Value
2022: PROFESSIONAL CARE SERVICES OF WEST TN, INC. 2022 401k membership
Total participants, beginning-of-year 2022-02-01 127
Total number of active participants reported on line 7a of the Form 5500 2022-02-01 132
Total of all active and inactive participants 2022-02-01 132
Total participants 2022-02-01 132
2021: PROFESSIONAL CARE SERVICES OF WEST TN, INC. 2021 401k membership
Total participants, beginning-of-year 2021-02-01 119
Total number of active participants reported on line 7a of the Form 5500 2021-02-01 127
Number of retired or separated participants receiving benefits 2021-02-01 0
Number of other retired or separated participants entitled to future benefits 2021-02-01 0
Total of all active and inactive participants 2021-02-01 127
Total participants 2021-02-01 127

Measure	Date	Value
2022: PROFESSIONAL CARE SERVICES OF WEST TN, INC. 2022 401k membership
Total participants, beginning-of-year	2022-02-01	127
Total number of active participants reported on line 7a of the Form 5500	2022-02-01	132
Total of all active and inactive participants	2022-02-01	132
Total participants	2022-02-01	132
2021: PROFESSIONAL CARE SERVICES OF WEST TN, INC. 2021 401k membership
Total participants, beginning-of-year	2021-02-01	119
Total number of active participants reported on line 7a of the Form 5500	2021-02-01	127
Number of retired or separated participants receiving benefits	2021-02-01	0
Number of other retired or separated participants entitled to future benefits	2021-02-01	0
Total of all active and inactive participants	2021-02-01	127
Total participants	2021-02-01	127

Form 5500 Responses for PROFESSIONAL CARE SERVICES OF WEST TN, INC.

2022: PROFESSIONAL CARE SERVICES OF WEST TN, INC. 2022 form 5500 responses
2022-02-01	Type of plan entity	Single employer plan
2022-02-01	Submission has been amended	No
2022-02-01	This submission is the final filing	No
2022-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-02-01	Plan is a collectively bargained plan	No
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes
2021: PROFESSIONAL CARE SERVICES OF WEST TN, INC. 2021 form 5500 responses
2021-02-01	Type of plan entity	Single employer plan
2021-02-01	Submission has been amended	No
2021-02-01	This submission is the final filing	No
2021-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-02-01	Plan is a collectively bargained plan	No
2021-02-01	Plan funding arrangement – Insurance	Yes
2021-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

944805

Policy instance

Insurance contract or identification number	944805
Number of Individuals Covered	132
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $24,153
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
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	CANCER
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $112,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $558
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

381082080

Policy instance

Insurance contract or identification number	381082080
Number of Individuals Covered	127
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $24,429
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
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	CANCER
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $99,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,804
Amount paid for insurance broker fees	1936
Insurance broker organization code?	3

Potentially related plans

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Company Name:	PROFESSIONAL CARE SERVICES OF WEST TN, INC.
Employer identification number (EIN):	621097170
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers