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CAPITOL CARE MEDICAL PLAN 401k Plan overview

Plan NameCAPITOL CARE MEDICAL PLAN
Plan identification number 501

CAPITOL CARE MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

CAPITOL CARE, INC. has sponsored the creation of one or more 401k plans.

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.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITOL CARE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-09-01ANDREW LUTZ
5012014-09-01SHEVA HERSH
5012014-09-01ANDREW LUTZ
5012013-09-01SHEVA HERSH

Plan Statistics for CAPITOL CARE MEDICAL PLAN

401k plan membership statisitcs for CAPITOL CARE MEDICAL PLAN

Measure Date Value
2015: CAPITOL CARE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01125
Total number of active participants reported on line 7a of the Form 55002015-09-0188
Number of retired or separated participants receiving benefits2015-09-010
Number of other retired or separated participants entitled to future benefits2015-09-010
Total of all active and inactive participants2015-09-0188
2014: CAPITOL CARE MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01125
Total number of active participants reported on line 7a of the Form 55002014-09-010
Number of retired or separated participants receiving benefits2014-09-010
Number of other retired or separated participants entitled to future benefits2014-09-010
Total of all active and inactive participants2014-09-010
2013: CAPITOL CARE MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01100
Total number of active participants reported on line 7a of the Form 55002013-09-01125
Number of retired or separated participants receiving benefits2013-09-010
Number of other retired or separated participants entitled to future benefits2013-09-010
Total of all active and inactive participants2013-09-01125

Form 5500 Responses for CAPITOL CARE MEDICAL PLAN

2015: CAPITOL CARE MEDICAL PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: CAPITOL CARE MEDICAL PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Submission has been amendedNo
2014-09-01This submission is the final filingYes
2014-09-01This return/report is a short plan year return/report (less than 12 months)No
2014-09-01Plan is a collectively bargained planNo
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: CAPITOL CARE MEDICAL PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01First time form 5500 has been submittedYes
2013-09-01Submission has been amendedNo
2013-09-01This submission is the final filingNo
2013-09-01This return/report is a short plan year return/report (less than 12 months)No
2013-09-01Plan is a collectively bargained planNo
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberCC5828
Policy instance 1
Insurance contract or identification numberCC5828
Number of Individuals Covered123
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $33,709
Total amount of fees paid to insurance companyUSD $15,990
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
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 $712,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberCC5828
Policy instance 1
Insurance contract or identification numberCC5828
Number of Individuals Covered125
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $25,988
Total amount of fees paid to insurance companyUSD $12,519
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
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 $601,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,517
Insurance broker organization code?3
Amount paid for insurance broker fees12519
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker nameC C BENEFITS, INC.

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