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| Plan Name | HAVEN BEHAVIORAL HEALTHCARE, LLC HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | HAVEN BEHAVIORAL HEALTHCARE, LLC |
| Employer identification number (EIN): | 842094128 |
| 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 |
|---|---|---|---|---|---|
| 501 | 2023-08-01 | BINNY MONTENEGRO | |||
| 501 | 2022-08-01 | ||||
| 501 | 2022-08-01 | BINNY MONTENEGRO | |||
| 501 | 2021-08-01 | BINNY MONTENEGRO | 2023-01-04 |
| 2022: HAVEN BEHAVIORAL HEALTHCARE, LLC HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Submission has been amended | No |
| 2022-08-01 | This submission is the final filing | No |
| 2022-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-08-01 | Plan is a collectively bargained plan | No |
| 2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: HAVEN BEHAVIORAL HEALTHCARE, LLC HEALTH AND WELFARE PLAN 2021 form 5500 responses | ||
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | First time form 5500 has been submitted | Yes |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 00001D041406 |
| Policy instance | 4 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000400267160 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000400267157 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 925011 |
| Policy instance | 1 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000010267155 |
| Policy instance | 7 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000010267154 |
| Policy instance | 6 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000010267156 |
| Policy instance | 5 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | ACC0000034999 |
| Policy instance | 4 |
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 160842 |
| Policy instance | 3 |
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) | |
| Policy contract number | MZ0937280H0000A |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 925011 |
| Policy instance | 1 |
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