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| Plan Name | EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | M.R. TANNER DEVELOPMENT & CONSTRUCTION, LLC DBA M.R. TANNER CONSTRUCTI |
| Employer identification number (EIN): | 860821266 |
| NAIC Classification: | 237210 |
| NAIC Description: | Land Subdivision |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2009-02-01 | GREGORY J MARSH | MAURICE TANNER | 2010-10-06 | |
| 501 | 2009-02-01 | ROXANNE BAKER | 2021-06-10 |
| Measure | Date | Value |
|---|---|---|
| 2009: EMPLOYEE BENEFIT PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-02-01 | 31 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 21 |
| Total of all active and inactive participants | 2009-02-01 | 21 |
| Total participants | 2009-02-01 | 21 |
| Number of retired or separated participants receiving benefits | 2009-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-02-01 | 0 |
| Number of employers contributing to the scheme | 2009-02-01 | 0 |
| 2009: EMPLOYEE BENEFIT PLAN 2009 form 5500 responses | ||
|---|---|---|
| 2009-02-01 | Type of plan entity | Mulitple employer plan |
| 2009-02-01 | Submission has been amended | Yes |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) | |
| Policy contract number | S5011B1 |
| Policy instance | 1 |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) | |
| Policy contract number | S5011B1 |
| Policy instance | 2 |
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) | |
| Policy contract number | S5011B1 |
| Policy instance | 3 |