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| Plan Name | BOXED WHOLESALE HEALTH & WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BLOSSOM MERGER SUB II LLC |
| Employer identification number (EIN): | 872528041 |
| NAIC Classification: | 424400 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-06-01 | KRISTEN CURY | 2023-03-14 | ||
| 501 | 2020-06-01 | KRISTEN CURY | 2023-03-14 |
| Measure | Date | Value |
|---|---|---|
| 2021: BOXED WHOLESALE HEALTH & WELFARE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-06-01 | 226 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 253 |
| Number of retired or separated participants receiving benefits | 2021-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-06-01 | 0 |
| Total of all active and inactive participants | 2021-06-01 | 253 |
| Number of employers contributing to the scheme | 2021-06-01 | 0 |
| 2020: BOXED WHOLESALE HEALTH & WELFARE PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-06-01 | 235 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 226 |
| Number of retired or separated participants receiving benefits | 2020-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 0 |
| Total of all active and inactive participants | 2020-06-01 | 226 |
| Number of employers contributing to the scheme | 2020-06-01 | 0 |
| 2021: BOXED WHOLESALE HEALTH & WELFARE PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | Submission has been amended | Yes |
| 2021-06-01 | Plan funding arrangement – Insurance | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: BOXED WHOLESALE HEALTH & WELFARE PLAN 2020 form 5500 responses | ||
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | Submission has been amended | Yes |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 527834 |
| Policy instance | 1 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 629689 |
| Policy instance | 2 |
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