EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN 401k Plan overview
| Plan Name | EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN |
| Plan identification number | 502 |
EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN Benefits
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits | - Health (other than dental or vision)
|
401k Sponsoring company profile
EVERGREEN EYE CARE, LLC has sponsored the creation of one or more 401k plans.
| Company Name: | EVERGREEN EYE CARE, LLC |
| Employer identification number (EIN): | 261526249 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
Additional information about EVERGREEN EYE CARE, LLC
| Jurisdiction of Incorporation: | Washington Secretary of State Corporations Division |
| Incorporation Date: | 2007-12-06 |
| Company Identification Number: | 602784577 |
| Legal Registered Office Address: |
1319 NE 134TH ST SUITE 107
VANCOUVER
United States of America (USA)
98685
|
More information about EVERGREEN EYE CARE, LLC
Form 5500 Filing Information
Submission information for form 5500 for 401k plan EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 502 | 2021-01-01 | | | | |
Plan Statistics for EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN
401k plan membership statisitcs for EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN
| Measure | Date | Value |
|---|
| 2021: EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 6 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 0 |
Financial Data on EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN
| Measure | Date | Value |
|---|
| 2021 : EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $15,301 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $15,301 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $11,727 |
| Total plan assets at end of year | 2021-12-31 | $0 |
| Total plan assets at beginning of year | 2021-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $15,301 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $3,574 |
Form 5500 Responses for EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN
| 2021: EVERGREEN EYE CARE, PLLC SELF FUNDED MEDICAL REIMBURSEMENT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
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