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| Plan Name | BOSTON MOUNTAIN RURAL HEALTH CENTER EMPLOYEE DENTAL PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BOSTON MOUNTAIN RURAL HEALTH CENTER, INC. |
| Employer identification number (EIN): | 710717967 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2021-03-01 | BECKY BLAIR | 2022-08-03 | BECKY BLAIR | 2022-08-03 |
| 503 | 2020-03-01 | BECKY BLAIR | 2021-10-13 | BECKY BLAIR | 2021-10-13 |
| Measure | Date | Value |
|---|---|---|
| 2021: BOSTON MOUNTAIN RURAL HEALTH CENTER EMPLOYEE DENTAL PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-03-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 0 |
| 2020: BOSTON MOUNTAIN RURAL HEALTH CENTER EMPLOYEE DENTAL PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-03-01 | 163 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 159 |
| Number of retired or separated participants receiving benefits | 2020-03-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2020-03-01 | 0 |
| Total of all active and inactive participants | 2020-03-01 | 162 |
| 2021: BOSTON MOUNTAIN RURAL HEALTH CENTER EMPLOYEE DENTAL PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | Submission has been amended | No |
| 2021-03-01 | This submission is the final filing | Yes |
| 2021-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-03-01 | Plan is a collectively bargained plan | No |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: BOSTON MOUNTAIN RURAL HEALTH CENTER EMPLOYEE DENTAL PLAN 2020 form 5500 responses | ||
| 2020-03-01 | Type of plan entity | Single employer plan |
| 2020-03-01 | First time form 5500 has been submitted | Yes |
| 2020-03-01 | Submission has been amended | No |
| 2020-03-01 | This submission is the final filing | No |
| 2020-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-03-01 | Plan is a collectively bargained plan | No |
| 2020-03-01 | Plan funding arrangement – Insurance | Yes |
| 2020-03-01 | Plan benefit arrangement – Insurance | Yes |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) | |
| Policy contract number | 017611 |
| Policy instance | 1 |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) | |
| Policy contract number | 017611 |
| Policy instance | 1 |
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