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| Plan Name | RIVERSIDE SPINE & PHYSICIANS, LLC HEALTH & WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | RIVERSIDE SPINE & PHYSICIANS, LLC |
| Employer identification number (EIN): | 753046335 |
| NAIC Classification: | 621310 |
| NAIC Description: | Offices of Chiropractors |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2015-11-01 | SHAUN GREENE | |||
| 501 | 2014-11-01 | SHAUN GREENE |
| 2015: RIVERSIDE SPINE & PHYSICIANS, LLC HEALTH & WELFARE PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | Yes |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: RIVERSIDE SPINE & PHYSICIANS, LLC HEALTH & WELFARE PLAN 2014 form 5500 responses | ||
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | First time form 5500 has been submitted | Yes |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 49975 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 49975 |
| Policy instance | 2 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5469169 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 49975 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 49975 |
| Policy instance | 1 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5469169 |
| Policy instance | 3 |
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