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| Plan Name | SUPPLEMENTAL LIFE PLAN |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC. |
| Employer identification number (EIN): | 043634356 |
| NAIC Classification: | 621399 |
| NAIC Description: | Offices of All Other Miscellaneous Health Practitioners |
Additional information about BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.
| Jurisdiction of Incorporation: | Idaho Secretary Of State |
| Incorporation Date: | |
| Company Identification Number: | C143212 |
More information about BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2017-01-01 |
| 2017: SUPPLEMENTAL LIFE PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) | |
| Policy contract number | G22457 |
| Policy instance | 1 |
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