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| Plan Name | GROUP TERM LIFE |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC |
| Employer identification number (EIN): | 562107759 |
| 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 |
|---|---|---|---|---|---|
| 503 | 2022-08-01 | ||||
| 503 | 2022-08-01 | DIANE HEADINGS | |||
| 503 | 2021-08-01 | ||||
| 503 | 2021-08-01 | DIANE HEADINGS |
| Measure | Date | Value |
|---|---|---|
| 2022: GROUP TERM LIFE 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-08-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 135 |
| Total of all active and inactive participants | 2022-08-01 | 135 |
| Total participants | 2022-08-01 | 135 |
| 2021: GROUP TERM LIFE 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-08-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 122 |
| Total of all active and inactive participants | 2021-08-01 | 122 |
| Total participants | 2021-08-01 | 122 |
| 2022: GROUP TERM LIFE 2022 form 5500 responses | ||
|---|---|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Submission has been amended | No |
| 2022-08-01 | This submission is the final filing | No |
| 2022-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-08-01 | Plan is a collectively bargained plan | No |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: GROUP TERM LIFE 2021 form 5500 responses | ||
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | First time form 5500 has been submitted | Yes |
| 2021-08-01 | Submission has been amended | No |
| 2021-08-01 | This submission is the final filing | No |
| 2021-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-08-01 | Plan is a collectively bargained plan | No |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |
| Policy contract number | 50045022 |
| Policy instance | 1 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |
| Policy contract number | 50045022 |
| Policy instance | 1 |
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