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  5. Blue Cross of Idaho Health Service, Inc.

Blue Cross of Idaho Health Service, Inc.

Company Details

Name: Blue Cross of Idaho Health Service, Inc.
Jurisdiction: Idaho
Legal type: General Business Corporation (D)
Status: Active-Good Standing
Date of registration: 30 Dec 1977 (47 years ago)
Entity Number: 183405
Place of Formation: IDAHO
File Number: 183405
ZIP code: 83642
County: Ada County
Mailing Address: 3000 E PINE AVE MERIDIAN, ID 83642-5995

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
C3OAIV5QRQL8RHJV1W97 183405 US-ID GENERAL ACTIVE 1977-12-29

Addresses
Legal C/O CORPORATION SERVICE COMPANY, NAMPA, US-ID, US, 83686
Headquarters C/O CORPORATION SERVICE COMPANY, NAMPA, US-ID, US, 83686

Registration details
Registration Date 2012-11-19
Last Update 2024-05-31
Status LAPSED
Next Renewal 2024-05-30
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 183405

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLUE CROSS OF IDAHO RETIREE HEALTH REIMBURSEMENT ARRANGEMENT 2022 820344294 2023-11-06 BLUE CROSS OF IDAHO HEALTH SERVICE, INC. 275
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2016-06-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s DBA name BLUE CROSS OF IDAHO
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 300

Signature of
Role Plan administrator
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS OF IDAHO RETIREE HEALTH REIMBURSEMENT ARRANGEMENT 2022 820344294 2023-11-06 BLUE CROSS OF IDAHO HEALTH SERVICE, INC. 245
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2016-06-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s DBA name BLUE CROSS OF IDAHO
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 270

Signature of
Role Plan administrator
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS OF IDAHO RETIREE HEALTH REIMBURSEMENT ARRANGEMENT 2022 820344294 2023-11-06 BLUE CROSS OF IDAHO HEALTH SERVICE, INC. 235
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2016-06-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s DBA name BLUE CROSS OF IDAHO
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 247

Signature of
Role Plan administrator
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS OF IDAHO RETIREE HEALTH REIMBURSEMENT ARRANGEMENT 2022 820344294 2023-11-06 BLUE CROSS OF IDAHO HEALTH SERVICE, INC. 209
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2016-06-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s DBA name BLUE CROSS OF IDAHO
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 239

Signature of
Role Plan administrator
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS OF IDAHO RETIREE HEALTH REIMBURSEMENT ARRANGEMENT 2022 820344294 2023-11-06 BLUE CROSS OF IDAHO HEALTH SERVICE, INC. 208
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2016-06-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s DBA name BLUE CROSS OF IDAHO
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 213

Signature of
Role Plan administrator
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
HOSPITAL SURGICAL & DENTAL PREPAID BENEFIT PLAN 2022 820344294 2023-10-16 BLUE CROSS OF IDAHO HEALTH SERVICE, INC 1438
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1946-02-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s DBA name BLUE CROSS OF IDAHO
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 1430
Retired or separated participants receiving benefits 13

Signature of
Role Plan administrator
Date 2023-10-16
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-16
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
GROUP LIFE INSURANCE 2022 820344294 2023-07-28 BLUE CROSS OF IDAHO HEALTH SERVICE, INC 1160
File View Page
Three-digit plan number (PN) 504
Effective date of plan 2000-01-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s DBA name BLUE CROSS OF IDAHO
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 1095
Retired or separated participants receiving benefits 57

Signature of
Role Plan administrator
Date 2023-07-28
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-28
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS OF IDAHO RETIREE HEALTH REIMBURSEMENT ARRANGEMENT 2021 820344294 2023-11-06 BLUE CROSS OF IDAHO HEALTH SERVICE, INC 268
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2016-06-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s DBA name BLUE CROSS OF IDAHO
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 292

Signature of
Role Plan administrator
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-11-06
Name of individual signing SARA GOMEZ
Valid signature Filed with authorized/valid electronic signature
GROUP LIFE INSURANCE 2021 820344294 2022-05-19 BLUE CROSS OF IDAHO HEALTH SERVICE, INC 1008
File View Page
Three-digit plan number (PN) 504
Effective date of plan 2000-01-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 997
Other retired or separated participants entitled to future benefits 57

Signature of
Role Plan administrator
Date 2022-05-16
Name of individual signing BRENT DEROSIA
Valid signature Filed with authorized/valid electronic signature
HOSPITAL SURGICAL & DENTAL PREPAID BENEFIT PLAN 2021 820344294 2022-05-19 BLUE CROSS OF IDAHO HEALTH SERVICE, INC 1254
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1946-02-01
Business code 524140
Sponsor’s telephone number 2083454550
Plan sponsor’s mailing address 3000 E PINE AVE, MERIDIAN, ID, 836425995
Plan sponsor’s address 3000 E PINE AVE, MERIDIAN, ID, 836425995

Number of participants as of the end of the plan year
Active participants 1337
Retired or separated participants receiving benefits 23

Signature of
Role Plan administrator
Date 2022-05-16
Name of individual signing BRENT DEROSIA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 1305 12TH AVE RD, NAMPA, ID 83686

Filing

Filing Name Filing Number Filing date
Restated Articles 0005524403 2023-12-20
Change of Registered Office/Agent/Both (by Entity) 0005211049 2023-04-25
Change of Registered Office/Agent/Both (by Entity) 0004118372 2021-01-05
Restated Articles 0000780594 2010-06-09
Change of Registered Office/Agent/Both (by Entity) 0001647687 2009-01-26
Change of Registered Office/Agent/Both (by Entity) 0001647686 2006-07-21
Change of Registered Office/Agent/Both (by Entity) 0001647685 2003-10-23
Restated Articles 0000780596 1994-12-27
Legacy Amendment 0000780595 1979-05-30
Initial Filing 0000183405 1977-12-30

Related by officers

CORPORATION SERVICE COMPANY

TRG SETTLEMENT SERVICES, LLP JAMES COURT ASSOCIATES WALKER SAND AND GRAVEL, LTD. CO. RSM US LLP NISSAN EXTENDED SERVICES NORTH AMERICA, G.P. BROJO, A LIMITED PARTNERSHIP DELOITTE & TOUCHE LLP DELOITTE LLP POTANDON PRODUCE L.L.C. DELOITTE TAX LLP

Related by address

3000 E PINE AVE MERIDIAN, ID 83642-5995

IDAHO BENEFITS ADMINISTRATION, LLC

Date of last update: 03 Dec 2024

Sources: Idaho Secretary of State

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