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| Plan Name | SANDSTONE CARE MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SANDSTONE CARE COLORADO LLC |
| Employer identification number (EIN): | 474488925 |
| NAIC Classification: | 621510 |
| NAIC Description: | Medical and Diagnostic Laboratories |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | GRANT SCHMIDT | 2024-09-05 | ||
| 501 | 2022-10-01 | GRANT SCHMIDT | 2023-09-12 | ||
| 501 | 2021-10-01 | GRANT SCHMIDT | 2023-04-25 | ||
| 501 | 2020-10-01 | LUKE MATTEY | 2022-04-21 |
| 2023: SANDSTONE CARE MEDICAL PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: SANDSTONE CARE MEDICAL PLAN 2022 form 5500 responses | ||
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: SANDSTONE CARE MEDICAL PLAN 2021 form 5500 responses | ||
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: SANDSTONE CARE MEDICAL PLAN 2020 form 5500 responses | ||
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | First time form 5500 has been submitted | Yes |
| 2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 637978 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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