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| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | POTOMAC HEALTHCARE SOLUTIONS, LLC |
| Employer identification number (EIN): | 275080822 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-11-01 | WILLIAM A. JOSEPH | 2021-05-18 |
| Measure | Date | Value |
|---|---|---|
| 2019: 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-11-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 149 |
| Number of retired or separated participants receiving benefits | 2019-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-11-01 | 0 |
| Total of all active and inactive participants | 2019-11-01 | 149 |
| Number of employers contributing to the scheme | 2019-11-01 | 0 |
| 2019: 2019 form 5500 responses | ||
|---|---|---|
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) | |
| Policy contract number | 30052403 |
| Policy instance | 1 |
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) | |
| Policy contract number | A18341-000 |
| Policy instance | 2 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) | |
| Policy contract number | 10193880 |
| Policy instance | 3 |
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