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| Plan Name | CAPITOL CARE MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CAPITOL CARE, INC. |
| Employer identification number (EIN): | 223602896 |
| NAIC Classification: | 621112 |
| NAIC Description: | Offices of Physicians, Mental Health Specialists |
Additional information about CAPITOL CARE, INC.
| Jurisdiction of Incorporation: | Virginia Secretary of State |
| Incorporation Date: | 2004-10-01 |
| Company Identification Number: | 0624748 |
| Legal Registered Office Address: |
8460 B TYCO RD VIENNA United States of America (USA) 22182 |
More information about CAPITOL CARE, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2015-09-01 | ANDREW LUTZ | |||
| 501 | 2014-09-01 | SHEVA HERSH | |||
| 501 | 2014-09-01 | ANDREW LUTZ | |||
| 501 | 2013-09-01 | SHEVA HERSH |
| Measure | Date | Value |
|---|---|---|
| 2015: CAPITOL CARE MEDICAL PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-09-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 88 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 0 |
| Total of all active and inactive participants | 2015-09-01 | 88 |
| 2014: CAPITOL CARE MEDICAL PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-09-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 0 |
| Number of retired or separated participants receiving benefits | 2014-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 0 |
| Total of all active and inactive participants | 2014-09-01 | 0 |
| 2013: CAPITOL CARE MEDICAL PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-09-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 125 |
| Number of retired or separated participants receiving benefits | 2013-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-09-01 | 0 |
| Total of all active and inactive participants | 2013-09-01 | 125 |
| 2015: CAPITOL CARE MEDICAL PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Submission has been amended | No |
| 2015-09-01 | This submission is the final filing | No |
| 2015-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-09-01 | Plan is a collectively bargained plan | No |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: CAPITOL CARE MEDICAL PLAN 2014 form 5500 responses | ||
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Submission has been amended | No |
| 2014-09-01 | This submission is the final filing | Yes |
| 2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-09-01 | Plan is a collectively bargained plan | No |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: CAPITOL CARE MEDICAL PLAN 2013 form 5500 responses | ||
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | First time form 5500 has been submitted | Yes |
| 2013-09-01 | Submission has been amended | No |
| 2013-09-01 | This submission is the final filing | No |
| 2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-09-01 | Plan is a collectively bargained plan | No |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | CC5828 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | CC5828 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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