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| Plan Name | MEDICAL |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ACCORDIUS HEALTH AT CREEKSIDE CARE LLC |
| Employer identification number (EIN): | 815085255 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2018-06-01 | NAFTALI ZANZIPER | 2019-12-02 | ||
| 501 | 2017-06-01 |
| Measure | Date | Value |
|---|---|---|
| 2018: MEDICAL 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-06-01 | 625 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 667 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 672 |
| Number of employers contributing to the scheme | 2018-06-01 | 0 |
| 2017: MEDICAL 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-06-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 491 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 491 |
| 2018: MEDICAL 2018 form 5500 responses | ||
|---|---|---|
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: MEDICAL 2017 form 5500 responses | ||
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | First time form 5500 has been submitted | Yes |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 911428 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 911428 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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