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| Plan Name | PRUDENTIAL BASE LIFE, STD, LTD, AD&D |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BLUEFIELD HOSPITAL COMPANY LLC |
| Employer identification number (EIN): | 272372291 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
Additional information about BLUEFIELD HOSPITAL COMPANY LLC
| Jurisdiction of Incorporation: | State of Delaware Division of Corporations |
| Incorporation Date: | |
| Company Identification Number: | 4812810 |
More information about BLUEFIELD HOSPITAL COMPANY LLC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2022-01-01 | EDWINA NEWBERRY | 2023-06-01 | ||
| 504 | 2021-01-01 | EDWINA NEWBERRY | 2022-06-06 | ||
| 504 | 2020-01-01 | EDWINA NEWBERRY | 2021-08-13 | ||
| 504 | 2019-10-01 | EDWINA NEWBERRY | 2020-06-05 |
| 2022: PRUDENTIAL BASE LIFE, STD, LTD, AD&D 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | This submission is the final filing | Yes |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: PRUDENTIAL BASE LIFE, STD, LTD, AD&D 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: PRUDENTIAL BASE LIFE, STD, LTD, AD&D 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: PRUDENTIAL BASE LIFE, STD, LTD, AD&D 2019 form 5500 responses | ||
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | First time form 5500 has been submitted | Yes |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |||||||||||||||||||||||||
| Policy contract number | 59974 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |||||||||||||||||||||||||
| Policy contract number | 59974 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |||||||||||||||||||||||||
| Policy contract number | 59974 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |||||||||||||||||||||||||
| Policy contract number | 59974 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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