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| Plan Name | MENDOCINO COMMUNITY HEALTH CLINIC FSA |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MENDOCINO COMMUNITY HEALTH CLINIC, INC. |
| Employer identification number (EIN): | 680259045 |
| 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 |
|---|---|---|---|---|---|
| 505 | 2020-10-01 | ROD GRAINGER | 2021-08-16 | ||
| 505 | 2020-10-01 | ROD GRAINGER | 2022-07-07 |
| Measure | Date | Value |
|---|---|---|
| 2020: MENDOCINO COMMUNITY HEALTH CLINIC FSA 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-10-01 | 210 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 204 |
| Number of retired or separated participants receiving benefits | 2020-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
| Total of all active and inactive participants | 2020-10-01 | 204 |
| Number of employers contributing to the scheme | 2020-10-01 | 0 |
| 2020: MENDOCINO COMMUNITY HEALTH CLINIC FSA 2020 form 5500 responses | ||
|---|---|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | First time form 5500 has been submitted | Yes |
| 2020-10-01 | Submission has been amended | Yes |
| 2020-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
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