401k Plan data: CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN plan

CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

CEREBRAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: CEREBRAL, INC.

Employer identification number (EIN): 853753458

NAIC Classification: 621420
NAIC Description: Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-08-16 BRITTNEY HOFFMAN 2023-07-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-08-16	BRITTNEY HOFFMAN	2023-07-17

Plan Statistics for CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-08-16 736
Total number of active participants reported on line 7a of the Form 5500 2022-08-16 664
Number of retired or separated participants receiving benefits 2022-08-16 13
Number of other retired or separated participants entitled to future benefits 2022-08-16 0
Total of all active and inactive participants 2022-08-16 677

Measure	Date	Value
2022: CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-08-16	736
Total number of active participants reported on line 7a of the Form 5500	2022-08-16	664
Number of retired or separated participants receiving benefits	2022-08-16	13
Number of other retired or separated participants entitled to future benefits	2022-08-16	0
Total of all active and inactive participants	2022-08-16	677

Form 5500 Responses for CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN

2022: CEREBRAL, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-08-16	Type of plan entity	Single employer plan
2022-08-16	First time form 5500 has been submitted	Yes
2022-08-16	Submission has been amended	No
2022-08-16	This submission is the final filing	No
2022-08-16	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-08-16	Plan is a collectively bargained plan	No
2022-08-16	Plan funding arrangement – Insurance	Yes
2022-08-16	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L06219

Policy instance

Insurance contract or identification number	L06219
Number of Individuals Covered	723
Insurance policy start date	2022-08-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $54,760
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $2,219,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,760
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3

HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 )

Policy contract number

122144

Policy instance

Insurance contract or identification number	122144
Number of Individuals Covered	2
Insurance policy start date	2022-08-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $13,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

00039100

Policy instance

Insurance contract or identification number	00039100
Number of Individuals Covered	871
Insurance policy start date	2022-08-16
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $15,300
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $316,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,300
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

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Company Name:	CEREBRAL, INC.
Employer identification number (EIN):	853753458
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers