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| Plan Name | LIFECARE AMBULANCE FLEXIBLE BENEFIT PLAN |
| Plan identification number | 510 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | LIFECARE AMBULANCE SERVICE |
| Employer identification number (EIN): | 382441192 |
| NAIC Classification: | 621900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 510 | 2015-08-01 | DEANA POWELL | |||
| 510 | 2013-08-01 | RONALD SLAGELL | RONALD SLAGELL | 2014-10-06 | |
| 510 | 2012-08-01 | RON SLAGELL |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |
| Policy contract number | G000QA53 |
| Policy instance | 1 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |
| Policy contract number | G000AQ53 |
| Policy instance | 1 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | F018494 |
| Policy instance | 1 |
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