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| Plan Name | RIDGE AMBULANCE SERVICE GROUP HEALTH, DENTAL & LIFE INSURANCE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | RIDGE AMBULANCE SERVICE |
| Employer identification number (EIN): | 364021870 |
| NAIC Classification: | 621900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-06-01 | ||||
| 501 | 2018-06-01 | ||||
| 501 | 2017-06-01 | RAYMOND CALLAHAN | RAYMOND CALLAHAN | 2018-12-17 |
| Measure | Date | Value |
|---|---|---|
| 2019: RIDGE AMBULANCE SERVICE GROUP HEALTH, DENTAL & LIFE INSURANCE PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 145 |
| Number of retired or separated participants receiving benefits | 2019-06-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2019-06-01 | 0 |
| Total of all active and inactive participants | 2019-06-01 | 146 |
| 2018: RIDGE AMBULANCE SERVICE GROUP HEALTH, DENTAL & LIFE INSURANCE PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-06-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 112 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 113 |
| 2017: RIDGE AMBULANCE SERVICE GROUP HEALTH, DENTAL & LIFE INSURANCE PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-06-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 108 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 108 |
| 2019: RIDGE AMBULANCE SERVICE GROUP HEALTH, DENTAL & LIFE INSURANCE PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-06-01 | Type of plan entity | Single employer plan |
| 2019-06-01 | Submission has been amended | No |
| 2019-06-01 | This submission is the final filing | No |
| 2019-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-06-01 | Plan is a collectively bargained plan | No |
| 2019-06-01 | Plan funding arrangement – Insurance | Yes |
| 2019-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: RIDGE AMBULANCE SERVICE GROUP HEALTH, DENTAL & LIFE INSURANCE PLAN 2018 form 5500 responses | ||
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Submission has been amended | No |
| 2018-06-01 | This submission is the final filing | No |
| 2018-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-06-01 | Plan is a collectively bargained plan | No |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: RIDGE AMBULANCE SERVICE GROUP HEALTH, DENTAL & LIFE INSURANCE PLAN 2017 form 5500 responses | ||
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | First time form 5500 has been submitted | Yes |
| 2017-06-01 | Submission has been amended | No |
| 2017-06-01 | This submission is the final filing | No |
| 2017-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-06-01 | Plan is a collectively bargained plan | No |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 00U5303 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 10119641001 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 0U5303 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 659305 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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