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| Plan Name | WEST SIDE COMMUNITY HEALTH SERVICES VISION PLAN |
| Plan identification number | 509 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | WEST SIDE COMMUNITY HEALTH SERVICES |
| Employer identification number (EIN): | 237156236 |
| NAIC Classification: | 621498 |
| NAIC Description: | All Other Outpatient Care Centers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 509 | 2021-01-01 | CHRISTIE JANSEN | 2022-07-19 |
| Measure | Date | Value |
|---|---|---|
| 2021: WEST SIDE COMMUNITY HEALTH SERVICES VISION PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 257 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 0 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2021: WEST SIDE COMMUNITY HEALTH SERVICES VISION PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 10308491001 |
| Policy instance | 1 |
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