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| Plan Name | THE BLUFFS EMPLOYEE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BOONE COUNTY SENIOR CITIZEN SERVICES CORP. |
| Employer identification number (EIN): | 431836344 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-05-01 | ||||
| 501 | 2023-05-01 | TAMMY KAIN | |||
| 501 | 2022-05-01 | ||||
| 501 | 2022-05-01 | TAMMY KAIN |
| Measure | Date | Value |
|---|---|---|
| 2023: THE BLUFFS EMPLOYEE BENEFITS PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-05-01 | 62 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-05-01 | 76 |
| Number of retired or separated participants receiving benefits | 2023-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-05-01 | 0 |
| Total of all active and inactive participants | 2023-05-01 | 76 |
| Total participants | 2023-05-01 | 76 |
| 2022: THE BLUFFS EMPLOYEE BENEFITS PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-05-01 | 66 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 66 |
| Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
| Total of all active and inactive participants | 2022-05-01 | 66 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2022-05-01 | 0 |
| Total participants | 2022-05-01 | 66 |
| Number of participants with account balances | 2022-05-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2022-05-01 | 0 |
| 2023: THE BLUFFS EMPLOYEE BENEFITS PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-05-01 | Type of plan entity | Single employer plan |
| 2023-05-01 | Submission has been amended | No |
| 2023-05-01 | This submission is the final filing | Yes |
| 2023-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-05-01 | Plan is a collectively bargained plan | No |
| 2023-05-01 | Plan funding arrangement – Insurance | Yes |
| 2023-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: THE BLUFFS EMPLOYEE BENEFITS PLAN 2022 form 5500 responses | ||
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | First time form 5500 has been submitted | Yes |
| 2022-05-01 | Submission has been amended | No |
| 2022-05-01 | This submission is the final filing | No |
| 2022-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-05-01 | Plan is a collectively bargained plan | No |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | L05610 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | CM10001496 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | CM10001496 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | L05610 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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