401k Plan data: JOHN BROOKS RECOVERY CENTER plan

JOHN BROOKS RECOVERY CENTER 401k Plan overview

Plan Name	JOHN BROOKS RECOVERY CENTER
Plan identification number	501

JOHN BROOKS RECOVERY CENTER Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

JOHN BROOKS RECOVERY CENTER has sponsored the creation of one or more 401k plans.

Company Name: JOHN BROOKS RECOVERY CENTER

Employer identification number (EIN): 221901742

NAIC Classification: 621498
NAIC Description: All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN BROOKS RECOVERY CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-07-01 MICHAEL SANTILLO 2023-04-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-07-01	MICHAEL SANTILLO	2023-04-18

Plan Statistics for JOHN BROOKS RECOVERY CENTER

401k plan membership statisitcs for JOHN BROOKS RECOVERY CENTER

Measure Date Value
2021: JOHN BROOKS RECOVERY CENTER 2021 401k membership
Total participants, beginning-of-year 2021-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 130
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 130
Number of employers contributing to the scheme 2021-07-01 0

Measure	Date	Value
2021: JOHN BROOKS RECOVERY CENTER 2021 401k membership
Total participants, beginning-of-year	2021-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	130
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	130
Number of employers contributing to the scheme	2021-07-01	0

Form 5500 Responses for JOHN BROOKS RECOVERY CENTER

2021: JOHN BROOKS RECOVERY CENTER 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	First time form 5500 has been submitted	Yes
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

4106508

Policy instance

Insurance contract or identification number	4106508
Number of Individuals Covered	109
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,779
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,779
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

225941

Policy instance

Insurance contract or identification number	225941
Number of Individuals Covered	13
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $983
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $4,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $983
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80841

Policy instance

Insurance contract or identification number	80841
Number of Individuals Covered	125
Insurance policy start date	2021-07-07
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $55,584
Total amount of fees paid to insurance company	USD $14,166
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $1,455,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,584
Amount paid for insurance broker fees	14166
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL164510

Policy instance

Insurance contract or identification number	GL164510
Number of Individuals Covered	130
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $2,493
Total amount of fees paid to insurance company	USD $132
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	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $24,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,493
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER FEES

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Company Name:	JOHN BROOKS RECOVERY CENTER
Employer identification number (EIN):	221901742
NAIC Classification:	621498
NAIC Description:	All Other Outpatient Care Centers