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| Plan Name | PENNSYLVANIA AMBULANCE, LLC GROUP INSURANCE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PENNSYLVANIA AMBULANCE |
| Employer identification number (EIN): | 462961683 |
| NAIC Classification: | 621399 |
| NAIC Description: | Offices of All Other Miscellaneous Health Practitioners |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2021-08-31 | ||||
| 502 | 2021-08-31 | MICHAEL MANCUSO |
| 2021: PENNSYLVANIA AMBULANCE, LLC GROUP INSURANCE PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-08-31 | Type of plan entity | Single employer plan |
| 2021-08-31 | First time form 5500 has been submitted | Yes |
| 2021-08-31 | Submission has been amended | No |
| 2021-08-31 | This submission is the final filing | No |
| 2021-08-31 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-08-31 | Plan is a collectively bargained plan | No |
| 2021-08-31 | Plan funding arrangement – Insurance | Yes |
| 2021-08-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-08-31 | Plan benefit arrangement – Insurance | Yes |
| 2021-08-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) | |
| Policy contract number | 2178 |
| Policy instance | 1 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 0042929 |
| Policy instance | 2 |
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