| Plan Name | FAMILY MEDICAL AND URGENT CARE CLINIC OF MCDONOUGH MEDOVA LIFESTYLE HEALTH PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FAMILY MEDICAL AND URGENT CARE CLINIC OF MCDONOUGH |
| Employer identification number (EIN): | 364810354 |
| 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 | 2020-04-01 | ROBERT MOORE | 2021-12-27 |