| Plan Name | GOOD SAMARITAN HOSPICE, INC. HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GOOD SAMARITAN HOSPICE, INC. |
| Employer identification number (EIN): | 541608259 |
| NAIC Classification: | 621399 |
| NAIC Description: | Offices of All Other Miscellaneous Health Practitioners |
Additional information about GOOD SAMARITAN HOSPICE, INC.
| Jurisdiction of Incorporation: | Virginia Secretary of State |
| Incorporation Date: | 1991-12-13 |
| Company Identification Number: | 0385107 |
| Legal Registered Office Address: |
2408 ELECTRIC ROAD SW ROANOKE United States of America (USA) 24018 |
More information about GOOD SAMARITAN HOSPICE, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-07-01 | MELISSA LUCAS | 2024-10-14 |
| 2023: GOOD SAMARITAN HOSPICE, INC. HEALTH AND WELFARE PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-07-01 | Type of plan entity | Single employer plan |
| 2023-07-01 | First time form 5500 has been submitted | Yes |
| 2023-07-01 | Plan funding arrangement – Insurance | Yes |
| 2023-07-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||
| Policy contract number | 632920 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||
| Policy contract number | 22332 | ||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||
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