401k Plan data: RIGGS COMMUNITY HEALTH CENTER INC

RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN 401k Plan overview

Plan Name	RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN
Plan identification number	508

RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

RIGGS COMMUNITY HEALTH CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: RIGGS COMMUNITY HEALTH CENTER, INC.

Employer identification number (EIN): 351965865

NAIC Classification: 621498
NAIC Description: All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2023-01-01
508 2022-01-01

Plan Statistics for RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN

401k plan membership statisitcs for RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN

Measure Date Value
2023: RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 107
Total of all active and inactive participants 2023-01-01 107
Total participants 2023-01-01 107
Number of employers contributing to the scheme 2023-01-01 0
2022: RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 97
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 105
Total of all active and inactive participants 2022-01-01 105
Total participants 2022-01-01 105
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2023: RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	107
Total of all active and inactive participants	2023-01-01	107
Total participants	2023-01-01	107
Number of employers contributing to the scheme	2023-01-01	0
2022: RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	97
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	105
Total of all active and inactive participants	2022-01-01	105
Total participants	2022-01-01	105
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN

2023: RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: RIGGS COMMUNITY HEALTH CENTER INC - MEDICAL PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )

Policy contract number

1981

Policy instance

Insurance contract or identification number	1981
Number of Individuals Covered	107
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,368
Total amount of fees paid to insurance company	USD $39,120
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )

Policy contract number

1885

Policy instance

Insurance contract or identification number	1885
Number of Individuals Covered	105
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,913
Total amount of fees paid to insurance company	USD $35,040
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,913
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3
Amount paid for insurance broker fees	35040

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Company Name:	RIGGS COMMUNITY HEALTH CENTER, INC.
Employer identification number (EIN):	351965865
NAIC Classification:	621498
NAIC Description:	All Other Outpatient Care Centers