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| Plan Name | COMMUNITY HEALTH CENTERS OF BURLINGTON VISION PLAN |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | COMMUNITY HEALTH CENTERS OF BURLINGTON, INC. |
| Employer identification number (EIN): | 237182584 |
| NAIC Classification: | 621498 |
| NAIC Description: | All Other Outpatient Care Centers |
Additional information about COMMUNITY HEALTH CENTERS OF BURLINGTON, INC.
| Jurisdiction of Incorporation: | Vermont Secretary of State Corporations Division |
| Incorporation Date: | 1971-07-15 |
| Company Identification Number: | 41888 |
| Legal Registered Office Address: |
Community Health Centers of Burlington 617 Riverside Avenue Burlington United States of America (USA) 05401 |
More information about COMMUNITY HEALTH CENTERS OF BURLINGTON, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2017-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2017: COMMUNITY HEALTH CENTERS OF BURLINGTON VISION PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 0 |
| 2017: COMMUNITY HEALTH CENTERS OF BURLINGTON VISION 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 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | Yes |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30053992 |
| Policy instance | 1 |