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| Plan Name | PRIME HOME HEALTH SERVICES, LLC EMPLOYEE BENEFITS PLAN |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PRIME HOME HEALTH SERVICES, LLC |
| Employer identification number (EIN): | 205202959 |
| NAIC Classification: | 621610 |
| NAIC Description: | Home Health Care Services |
Additional information about PRIME HOME HEALTH SERVICES, LLC
| Jurisdiction of Incorporation: | New York Department of State |
| Incorporation Date: | 2006-07-12 |
| Company Identification Number: | 3387124 |
| Legal Registered Office Address: |
3125 EMMONS AVENUE Kings BROOKLYN United States of America (USA) 11235 |
More information about PRIME HOME HEALTH SERVICES, LLC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2019-10-01 | ADRIANA CUESTA | 2021-07-13 | ADRIANA CUESTA | 2021-07-13 |
| 505 | 2019-10-01 | ADRIANA CUESTA | 2022-01-25 | ADRIANA CUESTA | 2022-01-25 |
| 505 | 2018-10-01 | ADRIANA CUESTA | 2020-02-28 | ||
| 505 | 2018-10-01 | ADRIANA CUESTA | 2021-07-13 | ADRIANA CUESTA | 2021-07-13 |
| Measure | Date | Value |
|---|---|---|
| 2019: PRIME HOME HEALTH SERVICES, LLC EMPLOYEE BENEFITS PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-10-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 148 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
| Total of all active and inactive participants | 2019-10-01 | 148 |
| 2018: PRIME HOME HEALTH SERVICES, LLC EMPLOYEE BENEFITS PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-10-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 178 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
| Total of all active and inactive participants | 2018-10-01 | 178 |
| Number of employers contributing to the scheme | 2018-10-01 | 0 |
| 2019: PRIME HOME HEALTH SERVICES, LLC EMPLOYEE BENEFITS PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Submission has been amended | No |
| 2019-10-01 | This submission is the final filing | No |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-10-01 | Plan is a collectively bargained plan | No |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: PRIME HOME HEALTH SERVICES, LLC EMPLOYEE BENEFITS PLAN 2018 form 5500 responses | ||
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | First time form 5500 has been submitted | Yes |
| 2018-10-01 | Submission has been amended | Yes |
| 2018-10-01 | This submission is the final filing | No |
| 2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-10-01 | Plan is a collectively bargained plan | No |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0238408 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0919127 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | PH8343 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | 00470624 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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