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| Plan Name | HISTOPATHOLOGY SERVICES ANCILLARY BENEFIT PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PATHLINE, LLC |
| Employer identification number (EIN): | 264236145 |
| 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 |
|---|---|---|---|---|---|
| 504 | 2017-09-01 | SUSAN SHIELDS FURCHAK | 2019-04-05 | ||
| 504 | 2016-09-01 | TAMMY HUNT |
| Measure | Date | Value |
|---|---|---|
| 2017: HISTOPATHOLOGY SERVICES ANCILLARY BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-09-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 4 |
| Total of all active and inactive participants | 2017-09-01 | 7 |
| Number of employers contributing to the scheme | 2017-09-01 | 0 |
| 2016: HISTOPATHOLOGY SERVICES ANCILLARY BENEFIT PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-09-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 120 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 120 |
| 2017: HISTOPATHOLOGY SERVICES ANCILLARY BENEFIT PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | This submission is the final filing | Yes |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: HISTOPATHOLOGY SERVICES ANCILLARY BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | First time form 5500 has been submitted | Yes |
| 2016-09-01 | Submission has been amended | No |
| 2016-09-01 | This submission is the final filing | No |
| 2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-09-01 | Plan is a collectively bargained plan | No |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 616724 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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