401k Plan data: ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN plan

ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

ACHIEVING TRUE SELF, INC. HEALTH AND 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) Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

ACHIEVING TRUE SELF has sponsored the creation of one or more 401k plans.

Company Name: ACHIEVING TRUE SELF

Employer identification number (EIN): 813694526

NAIC Classification: 621330
NAIC Description: Offices of Mental Health Practitioners (except Physicians)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-05-01 RICK J. MURRAY 2023-11-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-05-01	RICK J. MURRAY	2023-11-15

Plan Statistics for ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-05-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-05-01 174
Number of retired or separated participants receiving benefits 2022-05-01 0
Number of other retired or separated participants entitled to future benefits 2022-05-01 0
Total of all active and inactive participants 2022-05-01 174
Number of employers contributing to the scheme 2022-05-01 0

Measure	Date	Value
2022: ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-05-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-05-01	174
Number of retired or separated participants receiving benefits	2022-05-01	0
Number of other retired or separated participants entitled to future benefits	2022-05-01	0
Total of all active and inactive participants	2022-05-01	174
Number of employers contributing to the scheme	2022-05-01	0

Form 5500 Responses for ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN

2022: ACHIEVING TRUE SELF, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	First time form 5500 has been submitted	Yes
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00619924

Policy instance

Insurance contract or identification number	G00619924
Number of Individuals Covered	174
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $656
Total amount of fees paid to insurance company	USD $316
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $6,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $538
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OTHER COMPENSATION

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

27615

Policy instance

Insurance contract or identification number	27615
Number of Individuals Covered	48
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $10,002
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $33,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,780
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

274798

Policy instance

Insurance contract or identification number	274798
Number of Individuals Covered	119
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $23,122
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $585,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,121
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	ACHIEVING TRUE SELF
Employer identification number (EIN):	813694526
NAIC Classification:	621330
NAIC Description:	Offices of Mental Health Practitioners (except Physicians)