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| Plan Name | BERT NASH BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BERT NASH COMMUNITY MENTAL HEALTH CENTER INC. |
| Employer identification number (EIN): | 480775739 |
| 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 | 2023-06-01 | PATRICK SCHMITZ | |||
| 501 | 2022-06-01 | ||||
| 501 | 2022-06-01 | PATRICK SCHMITZ |
| 2022: BERT NASH BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | First time form 5500 has been submitted | Yes |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) | |
| Policy contract number | 660596758 |
| Policy instance | 1 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 953067 |
| Policy instance | 2 |
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) | |
| Policy contract number | 54917-000-00001 |
| Policy instance | 3 |
| SURENCY LIFE AND HEALTH (National Association of Insurance Commissioners NAIC id number: 13175 ) | |
| Policy contract number | 54917-000-00001 |
| Policy instance | 4 |
| DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) | |
| Policy contract number | 54917-000-00002 |
| Policy instance | 5 |
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