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| Plan Name | PINNACLE MEDICAL GROUP, INC. A PROFESSIONAL CORPORATION HEALTH & WELLNESS PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PINNACLE MEDICAL GROUP, INC. |
| Employer identification number (EIN): | 770508373 |
| NAIC Classification: | 621498 |
| NAIC Description: | All Other Outpatient Care Centers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2017-12-01 | SHELLEY MCGEE | 2019-09-11 |
| 2017: PINNACLE MEDICAL GROUP, INC. A PROFESSIONAL CORPORATION HEALTH & WELLNESS PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | First time form 5500 has been submitted | Yes |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-12-01 | 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 | 621015 |
| Policy instance | 1 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | SGM608669 |
| Policy instance | 2 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | S7445 |
| Policy instance | 3 |
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