401k Plan data: THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN plan

THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN 401k Plan overview

Plan Name	THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN
Plan identification number	501

THE OCD & ANXIETY TREATMENT CENTER 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) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

THE OCD & ANXIETY TREATMENT CENTER has sponsored the creation of one or more 401k plans.

Company Name: THE OCD & ANXIETY TREATMENT CENTER

Employer identification number (EIN): 474089981

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 PAUL PETERSON 2023-06-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	PAUL PETERSON	2023-06-28

Plan Statistics for THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN

401k plan membership statisitcs for THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN

Measure Date Value
2022: THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 102
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 102
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	102
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	102
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN

2022: THE OCD & ANXIETY TREATMENT CENTER WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

7486

Policy instance

Insurance contract or identification number	7486
Number of Individuals Covered	102
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,578
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $25,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $2,480
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 )

Policy contract number

G1018652 1001

Policy instance

Insurance contract or identification number	G1018652 1001
Number of Individuals Covered	55
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $29,160
Total amount of fees paid to insurance company	USD $6,415
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
Welfare Benefit Premiums Paid to Carrier	USD $426,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,560
Amount paid for insurance broker fees	4303
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 12515 )

Policy contract number

4919

Policy instance

Insurance contract or identification number	4919
Number of Individuals Covered	84
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,173
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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 $29,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,421
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

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Company Name:	THE OCD & ANXIETY TREATMENT CENTER
Employer identification number (EIN):	474089981
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists