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| Plan Name | BOSTON MOUNTAIN RURAL HEALTH CENTER EMPLOYEE AD&D & LIFE PLAN |
| Plan identification number | 504 |
| 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 |
|---|---|---|---|---|---|
| 504 | 2021-03-01 | BECKY BLAIR | 2022-08-03 | BECKY BLAIR | 2022-08-03 |
| 504 | 2020-03-01 | BECKY BLAIR | 2021-10-13 | BECKY BLAIR | 2021-10-13 |
| 2021: BOSTON MOUNTAIN RURAL HEALTH CENTER EMPLOYEE AD&D & LIFE 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 AD&D & LIFE 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 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |
| Policy contract number | 50003294 |
| Policy instance | 1 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |
| Policy contract number | 50003294 |
| Policy instance | 1 |
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