401k Plan data: OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN plan

OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN 401k Plan overview

Plan Name	OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN
Plan identification number	502

OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

MEDCURA HEALTH, INC. has sponsored the creation of one or more 401k plans.

Company Name: MEDCURA HEALTH, INC.

Employer identification number (EIN): 581413957

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2019-10-01

Plan Statistics for OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN

401k plan membership statisitcs for OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN

Measure Date Value
2019: OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 105
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 0
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 0

Measure	Date	Value
2019: OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	105
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	0
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	0

Form 5500 Responses for OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN

2019: OAKHURST MEDICAL CENTERS LIFE INSURANCE PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	First time form 5500 has been submitted	Yes
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	Yes
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )

Policy contract number

GA2617

Policy instance

Insurance contract or identification number	GA2617
Number of Individuals Covered	114
Insurance policy start date	2020-05-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $1,642
Total amount of fees paid to insurance company	USD $0
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $20,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,091
Insurance broker organization code?	3

GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )

Policy contract number

GA2617

Policy instance

Insurance contract or identification number	GA2617
Number of Individuals Covered	104
Insurance policy start date	2019-10-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $3,769
Total amount of fees paid to insurance company	USD $0
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $33,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,769
Insurance broker organization code?	3

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Company Name:	MEDCURA HEALTH, INC.
Employer identification number (EIN):	581413957
NAIC Classification:	622000
NAIC Description:	Hospitals