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| Plan Name | MORAVIA HEALTHCARE NETWORK, LLC MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MORAVIA HEALTHCARE NETWORK, LLC |
| Employer identification number (EIN): | 273049364 |
| NAIC Classification: | 446190 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-12-01 | FEBEN HABTE | 2024-03-26 | ||
| 501 | 2021-12-01 | FEBEN HABTE | 2023-02-13 | ||
| 501 | 2020-12-01 | FEBEN HABTE | 2022-04-25 | ||
| 501 | 2019-12-01 | FEBEN HABTE | 2021-07-16 |
| 2022: MORAVIA HEALTHCARE NETWORK, LLC MEDICAL PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-12-01 | Type of plan entity | Single employer plan |
| 2022-12-01 | Plan funding arrangement – Insurance | Yes |
| 2022-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MORAVIA HEALTHCARE NETWORK, LLC MEDICAL PLAN 2021 form 5500 responses | ||
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MORAVIA HEALTHCARE NETWORK, LLC MEDICAL PLAN 2020 form 5500 responses | ||
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: MORAVIA HEALTHCARE NETWORK, LLC MEDICAL PLAN 2019 form 5500 responses | ||
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | First time form 5500 has been submitted | Yes |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 929633 |
| Policy instance | 1 |
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) | |
| Policy contract number | 2202785 |
| Policy instance | 1 |
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) | |
| Policy contract number | 2202785 |
| Policy instance | 2 |
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) | |
| Policy contract number | 2202785 |
| Policy instance | 1 |
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) | |
| Policy contract number | 2202785 |
| Policy instance | 2 |
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) | |
| Policy contract number | 2202785 |
| Policy instance | 1 |
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) | |
| Policy contract number | 2202785 |
| Policy instance | 2 |
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