401k Plan data: RIGGS COMMUNITY HEALTH CENTER, INC.

RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN 401k Plan overview

Plan Name	RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN
Plan identification number	513

RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

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. - LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
513 2023-01-01

Plan Statistics for RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN

401k plan membership statisitcs for RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN

Measure Date Value
2023: RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 173
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 173
Total of all active and inactive participants 2023-01-01 173
Total participants 2023-01-01 173
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	173
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	173
Total of all active and inactive participants	2023-01-01	173
Total participants	2023-01-01	173
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN

2023: RIGGS COMMUNITY HEALTH CENTER, INC. - LONG TERM DISABILITY PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000C2FF

Policy instance

Insurance contract or identification number	G000C2FF
Number of Individuals Covered	173
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,199
Total amount of fees paid to insurance company	USD $765
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	No
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $41,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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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