401k Plan data: ADAPTIVE COMMUNITY SUPPORT SERVICES EMPLOYEE WELFARE PLAN plan

ADAPTIVE COMMUNITY SUPPORT SERVICES EMPLOYEE WELFARE PLAN 401k Plan overview

Plan Name	ADAPTIVE COMMUNITY SUPPORT SERVICES EMPLOYEE WELFARE PLAN
Plan identification number	501

ADAPTIVE COMMUNITY SUPPORT SERVICES EMPLOYEE WELFARE 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) Other welfare benefit cover

401k Sponsoring company profile

ADAPTIVE COMMUNITY SUPPORT SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: ADAPTIVE COMMUNITY SUPPORT SERVICES, INC.

Employer identification number (EIN): 473746811

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADAPTIVE COMMUNITY SUPPORT SERVICES EMPLOYEE WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-08-01 BETH TOURNEY-SHELTON 2025-01-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-08-01	BETH TOURNEY-SHELTON	2025-01-10

Form 5500 Responses for ADAPTIVE COMMUNITY SUPPORT SERVICES EMPLOYEE WELFARE PLAN

2023: ADAPTIVE COMMUNITY SUPPORT SERVICES EMPLOYEE WELFARE PLAN 2023 form 5500 responses
2023-08-01	Type of plan entity	Single employer plan
2023-08-01	First time form 5500 has been submitted	Yes
2023-08-01	Plan funding arrangement – Insurance	Yes
2023-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

665026

Policy instance

Insurance contract or identification number	665026
Number of Individuals Covered	83
Insurance policy start date	2023-08-01
Insurance policy end date	2024-07-31
Total amount of commissions paid to insurance broker	USD $17,855
Total amount of fees paid to insurance company	USD $3,459
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $385,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

575074

Policy instance

Insurance contract or identification number	575074
Number of Individuals Covered	116
Insurance policy start date	2023-08-01
Insurance policy end date	2024-07-31
Total amount of commissions paid to insurance broker	USD $8,636
Total amount of fees paid to insurance company	USD $2,886
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $87,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

252597

Policy instance

Insurance contract or identification number	252597
Number of Individuals Covered	52
Insurance policy start date	2023-08-01
Insurance policy end date	2024-07-31
Total amount of commissions paid to insurance broker	USD $11,233
Total amount of fees paid to insurance company	USD $878
Health Insurance Welfare Benefit	No
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
Other welfare benefits provided	CRITICAL ILLNESS, ACCIDENT, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $20,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ADAPTIVE COMMUNITY SUPPORT SERVICES, INC.
Employer identification number (EIN):	473746811
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners