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| Plan Name | TWO CHAIRS BEHAVIORAL HEALTH GROUP HEALTH & WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | TWO CHAIRS BEHAVIORAL HEALTH GROUP |
| Employer identification number (EIN): | 815119771 |
| NAIC Classification: | 621112 |
| NAIC Description: | Offices of Physicians, Mental Health Specialists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2024-10-01 | LINDSEY TAYLOR | |||
| 501 | 2023-10-01 | ALEX KATZ | |||
| 501 | 2022-10-01 | ROSEMARY JONES | 2024-04-09 |
| 2022: TWO CHAIRS BEHAVIORAL HEALTH GROUP HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-10-01 | Type of plan entity | Multi-employer plan |
| 2022-10-01 | First time form 5500 has been submitted | Yes |
| 2022-10-01 | Plan is a collectively bargained plan | Yes |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00546197 |
| Policy instance | 1 |
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 61557 ) | |
| Policy contract number | W0091044 |
| Policy instance | 2 |
| HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 ) | |
| Policy contract number | 123272-1 |
| Policy instance | 3 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 727644 |
| Policy instance | 4 |
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