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POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 401k Plan overview

Plan NamePOTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN
Plan identification number 501

POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

POTOMAC CASE MANAGEMENT SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:POTOMAC CASE MANAGEMENT SERVICES, INC.
Employer identification number (EIN):522118801
NAIC Classification:621112
NAIC Description:Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01
5012021-07-01
5012020-07-01
5012020-05-01
5012019-05-01

Plan Statistics for POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN

401k plan membership statisitcs for POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN

Measure Date Value
2022: POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-0154
Total number of active participants reported on line 7a of the Form 55002022-07-0169
Number of retired or separated participants receiving benefits2022-07-011
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-0170
2021: POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-0165
Total number of active participants reported on line 7a of the Form 55002021-07-0154
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-0154
2020: POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-0165
Total number of active participants reported on line 7a of the Form 55002020-07-0163
Number of retired or separated participants receiving benefits2020-07-011
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-0164
Total participants, beginning-of-year2020-05-0165
Total number of active participants reported on line 7a of the Form 55002020-05-0165
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-0165
2019: POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-0161
Total number of active participants reported on line 7a of the Form 55002019-05-0165
Number of retired or separated participants receiving benefits2019-05-010
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-0165

Financial Data on POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN

Measure Date Value
2023 : POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2023 401k financial data
Total plan liabilities at end of year2023-06-30$87,855
Total plan liabilities at beginning of year2023-06-30$35,652
Total income from all sources2023-06-30$607,537
Expenses. Total of all expenses incurred2023-06-30$616,932
Benefits paid (including direct rollovers)2023-06-30$403,019
Total plan assets at end of year2023-06-30$63,754
Total plan assets at beginning of year2023-06-30$20,946
Value of fidelity bond covering the plan2023-06-30$30,000
Total contributions received or receivable from participants2023-06-30$600
Expenses. Other expenses not covered elsewhere2023-06-30$184,233
Contributions received from other sources (not participants or employers)2023-06-30$728
Other income received2023-06-30$0
Net income (gross income less expenses)2023-06-30$-9,395
Net plan assets at end of year (total assets less liabilities)2023-06-30$-24,101
Net plan assets at beginning of year (total assets less liabilities)2023-06-30$-14,706
Total contributions received or receivable from employer(s)2023-06-30$606,209
Value of corrective distributions2023-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2023-06-30$29,680
2022 : POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2022 401k financial data
Total plan liabilities at end of year2022-06-30$35,652
Total plan liabilities at beginning of year2022-06-30$24,059
Total income from all sources2022-06-30$373,071
Expenses. Total of all expenses incurred2022-06-30$378,361
Benefits paid (including direct rollovers)2022-06-30$232,695
Total plan assets at end of year2022-06-30$20,946
Total plan assets at beginning of year2022-06-30$14,643
Value of fidelity bond covering the plan2022-06-30$30,000
Total contributions received or receivable from participants2022-06-30$88,417
Expenses. Other expenses not covered elsewhere2022-06-30$122,436
Contributions received from other sources (not participants or employers)2022-06-30$628
Other income received2022-06-30$0
Net income (gross income less expenses)2022-06-30$-5,290
Net plan assets at end of year (total assets less liabilities)2022-06-30$-14,706
Net plan assets at beginning of year (total assets less liabilities)2022-06-30$-9,416
Total contributions received or receivable from employer(s)2022-06-30$284,026
Value of corrective distributions2022-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-06-30$23,230
2021 : POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2021 401k financial data
Total plan liabilities at end of year2021-06-30$24,059
Total plan liabilities at beginning of year2021-06-30$23,458
Total income from all sources2021-06-30$383,455
Expenses. Total of all expenses incurred2021-06-30$384,189
Benefits paid (including direct rollovers)2021-06-30$244,559
Total plan assets at end of year2021-06-30$14,643
Total plan assets at beginning of year2021-06-30$14,776
Value of fidelity bond covering the plan2021-06-30$30,000
Total contributions received or receivable from participants2021-06-30$87,181
Expenses. Other expenses not covered elsewhere2021-06-30$112,916
Net income (gross income less expenses)2021-06-30$-734
Net plan assets at end of year (total assets less liabilities)2021-06-30$-9,416
Net plan assets at beginning of year (total assets less liabilities)2021-06-30$-8,682
Total contributions received or receivable from employer(s)2021-06-30$296,274
Expenses. Administrative service providers (salaries,fees and commissions)2021-06-30$26,714
2020 : POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2020 401k financial data
Total plan liabilities at end of year2020-06-30$23,458
Total plan liabilities at beginning of year2020-06-30$23,834
Total income from all sources2020-06-30$139,234
Expenses. Total of all expenses incurred2020-06-30$114,490
Benefits paid (including direct rollovers)2020-06-30$37,673
Total plan assets at end of year2020-06-30$14,776
Total plan assets at beginning of year2020-06-30$-9,592
Value of fidelity bond covering the plan2020-06-30$30,000
Total contributions received or receivable from participants2020-06-30$20,622
Expenses. Other expenses not covered elsewhere2020-06-30$72,467
Contributions received from other sources (not participants or employers)2020-06-30$0
Other income received2020-06-30$0
Net income (gross income less expenses)2020-06-30$24,744
Net plan assets at end of year (total assets less liabilities)2020-06-30$-8,682
Net plan assets at beginning of year (total assets less liabilities)2020-06-30$-33,426
Total contributions received or receivable from employer(s)2020-06-30$118,612
Value of corrective distributions2020-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-06-30$4,350
Total plan liabilities at end of year2020-04-30$33,426
Total income from all sources2020-04-30$378,947
Expenses. Total of all expenses incurred2020-04-30$412,373
Benefits paid (including direct rollovers)2020-04-30$246,104
Total plan assets at end of year2020-04-30$0
Value of fidelity bond covering the plan2020-04-30$30,000
Total contributions received or receivable from participants2020-04-30$106,017
Expenses. Other expenses not covered elsewhere2020-04-30$137,856
Contributions received from other sources (not participants or employers)2020-04-30$0
Other income received2020-04-30$0
Noncash contributions received2020-04-30$0
Net income (gross income less expenses)2020-04-30$-33,426
Net plan assets at end of year (total assets less liabilities)2020-04-30$-33,426
Net plan assets at beginning of year (total assets less liabilities)2020-04-30$0
Total contributions received or receivable from employer(s)2020-04-30$272,930
Value of corrective distributions2020-04-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-04-30$28,413

Form 5500 Responses for POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN

2022: POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Submission has been amendedNo
2022-07-01This submission is the final filingNo
2022-07-01This return/report is a short plan year return/report (less than 12 months)No
2022-07-01Plan is a collectively bargained planNo
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – TrustYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement - TrustYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan funding arrangement – TrustYes
2020-05-01Plan benefit arrangement – InsuranceYes
2020-05-01Plan benefit arrangement - TrustYes
2019: POTOMAC CASE MANAGEMENT SERVICES, INC. GROUP HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01First time form 5500 has been submittedYes
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan funding arrangement – TrustYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL31000053
Policy instance 1
Insurance contract or identification numberSL31000053
Number of Individuals Covered70
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $143,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL31000053
Policy instance 1
Insurance contract or identification numberSL31000053
Number of Individuals Covered54
Insurance policy start date2021-05-01
Insurance policy end date2021-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $106,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL31000053
Policy instance 1
Insurance contract or identification numberSL31000053
Number of Individuals Covered63
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $105,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL31000053
Policy instance 1
Insurance contract or identification numberSL31000053
Number of Individuals Covered65
Insurance policy start date2020-05-01
Insurance policy end date2020-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $16,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL31000053
Policy instance 1
Insurance contract or identification numberSL31000053
Number of Individuals Covered65
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $95,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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