| Plan Name | PRIMARY CARE SERVICES BLOUNT HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PRIMARY CARE SERVICES - BLOUNT LLC |
| Employer identification number (EIN): | 205134447 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-12-01 | THOMAS BRITT TAYLOR | 2021-10-07 |