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| Plan Name | NORTHWEST SPECIALTY HOSPITAL MEDICAL, DENTAL AND VISION PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | NORTH IDAHO DAY SURGERY, LLC DBA NORTHWEST SPECIALTY HOSPITAL |
| Employer identification number (EIN): | 200002031 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2010-01-01 | RICK RASMUSSEN |
| 2010: NORTHWEST SPECIALTY HOSPITAL MEDICAL, DENTAL AND VISION PLAN 2010 form 5500 responses | ||
|---|---|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| REGENCE BLUESHIELD OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60131 ) | |
| Policy contract number | 60012751 |
| Policy instance | 1 |
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