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| Plan Name | CONVENIENTMD HEALTH & WELFARE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CONVENIENTMD URGENT CARE |
| Employer identification number (EIN): | 030709677 |
| NAIC Classification: | 621493 |
| NAIC Description: | Freestanding Ambulatory Surgical and Emergency Centers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2019-01-01 | AUBREY BUSSEY | 2020-05-20 | ||
| 502 | 2018-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2019: CONVENIENTMD HEALTH & WELFARE PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 179 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 335 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 335 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: CONVENIENTMD HEALTH & WELFARE PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 179 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 179 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2019: CONVENIENTMD HEALTH & WELFARE PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: CONVENIENTMD HEALTH & WELFARE PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| MATTHEW THORNTON HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 95527 ) | |
| Policy contract number | 365280 |
| Policy instance | 1 |
| NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) | |
| Policy contract number | 10998 |
| Policy instance | 2 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | AL00006351 |
| Policy instance | 3 |
| MATTHEW THORNTON HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 95527 ) | |
| Policy contract number | 365280 |
| Policy instance | 1 |
| NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) | |
| Policy contract number | 10998 |
| Policy instance | 2 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | AL00006351 |
| Policy instance | 3 |
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