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| Plan Name | HEALTH & WELFARE BENEFIT PLANS |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | COMMUNITY CARE COOPERATIVE |
| Employer identification number (EIN): | 813005904 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
Additional information about COMMUNITY CARE COOPERATIVE
| Jurisdiction of Incorporation: | Texas Secretary of State |
| Incorporation Date: | 2019-08-05 |
| Company Identification Number: | 0803387465 |
| Legal Registered Office Address: |
4400 ALMEDA RD # 88293 HOUSTON United States of America (USA) 77004 |
More information about COMMUNITY CARE COOPERATIVE
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-09-01 | PHILLY LAPTISTE | 2024-03-28 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) | |
| Policy contract number | 8073677 |
| Policy instance | 1 |
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