| Plan Name | FIRST CARE MGMT CO, LLC EMPLOYEE BENEFITS |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | FIRST CARE MGMT CO, LLC |
| Employer identification number (EIN): | 471828057 |
| NAIC Classification: | 621399 |
| NAIC Description: | Offices of All Other Miscellaneous Health Practitioners |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-03-01 | ANDREW M DEANE | 2021-10-04 | ||
| 501 | 2019-03-01 | ANDREW M DEANE | 2020-09-04 |
| 2020: FIRST CARE MGMT CO, LLC EMPLOYEE BENEFITS 2020 form 5500 responses | ||
|---|---|---|
| 2020-03-01 | Type of plan entity | Single employer plan |
| 2020-03-01 | Submission has been amended | No |
| 2020-03-01 | This submission is the final filing | No |
| 2020-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-03-01 | Plan is a collectively bargained plan | No |
| 2020-03-01 | Plan funding arrangement – Insurance | Yes |
| 2020-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: FIRST CARE MGMT CO, LLC EMPLOYEE BENEFITS 2019 form 5500 responses | ||
| 2019-03-01 | Type of plan entity | Single employer plan |
| 2019-03-01 | First time form 5500 has been submitted | Yes |
| 2019-03-01 | Submission has been amended | No |
| 2019-03-01 | This submission is the final filing | No |
| 2019-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-03-01 | Plan is a collectively bargained plan | No |
| 2019-03-01 | Plan funding arrangement – Insurance | Yes |
| 2019-03-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 140877 |
| Policy instance | 1 |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) | |
| Policy contract number | 01-017964-00 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 140877 |
| Policy instance | 1 |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) | |
| Policy contract number | 01-017964-00 |
| Policy instance | 2 |