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| Plan Name | BARTZ-ALTADONNA COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BARTZ-ALTADONNA COMMUNITY HEALTH CENTER |
| Employer identification number (EIN): | 273261289 |
| NAIC Classification: | 621498 |
| NAIC Description: | All Other Outpatient Care Centers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-01-01 | MARY CUMMINGS | 2023-05-19 | ||
| 501 | 2021-01-01 | MARY CUMMINGS | 2022-06-08 |
| Measure | Date | Value |
|---|---|---|
| 2022: BARTZ-ALTADONNA COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 142 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 147 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: BARTZ-ALTADONNA COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 99 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 99 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2022: BARTZ-ALTADONNA COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: BARTZ-ALTADONNA COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||
| Policy contract number | 67467 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||
| Policy contract number | 67467 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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