401k Plan data: AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN plan

AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

AMBULATORY MANAGEMENT SOLUTIONS, LLC has sponsored the creation of one or more 401k plans.

Company Name: AMBULATORY MANAGEMENT SOLUTIONS, LLC

Employer identification number (EIN): 451157458

NAIC Classification: 541611
NAIC Description: Administrative Management and General Management Consulting Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-01-01 JOSH GANTZ
501 2023-01-01
501 2023-01-01 JOSH GANTZ

Plan Statistics for AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2023: AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 157
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 168
Number of retired or separated participants receiving benefits 2023-01-01 3
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 171

Measure	Date	Value
2023: AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	157
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	168
Number of retired or separated participants receiving benefits	2023-01-01	3
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	171

Form 5500 Responses for AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN

2023: AMBULATORY MANAGEMENT SOLUTIONS, LLC HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00523469

Policy instance

Insurance contract or identification number	00523469
Number of Individuals Covered	130
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $17,830
Total amount of fees paid to insurance company	USD $951
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	Yes
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	ACCIDENTAL DEATH & DISMEMBERMENT
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 $113,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

307021

Policy instance

Insurance contract or identification number	307021
Number of Individuals Covered	228
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $60,697
Total amount of fees paid to insurance company	USD $15,000
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	Yes
Dental Insurance Welfare Benefit	No
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
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 $1,553,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

949848

Policy instance

Insurance contract or identification number	949848
Number of Individuals Covered	168
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $22,141
Total amount of fees paid to insurance company	USD $13,047
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	No
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	ACCIDENT, ACCIDENTAL DEATH & DISMEMBERMENT, CRITICAL ILLNESS
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 $183,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

AMBULATORY MANAGEMENT, LLC DEFINED BENEFIT PLAN [EIN = 260215003]

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Company Name:	AMBULATORY MANAGEMENT SOLUTIONS, LLC
Employer identification number (EIN):	451157458
NAIC Classification:	541611
NAIC Description:	Administrative Management and General Management Consulting Services