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| Plan Name | PROSPECT MEDICAL SYSTEMS GROUP EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PROSPECT MEDICAL SYSTEMS, LLC DBA PROSPECT MEDICAL |
| Employer identification number (EIN): | 330718606 |
| 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 | 2023-01-01 | LYNETTE JAMISON | 2024-08-16 |
| Measure | Date | Value |
|---|---|---|
| 2023: PROSPECT MEDICAL SYSTEMS GROUP EMPLOYEE BENEFIT PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-01-01 | 1,057 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 1,024 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 1,029 |
| Number of employers contributing to the scheme | 2023-01-01 | 0 |
| 2023: PROSPECT MEDICAL SYSTEMS GROUP EMPLOYEE BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | First time form 5500 has been submitted | Yes |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 22174 | ||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 40151951 | ||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||
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| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 761944 | ||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||
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