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| Plan Name | EXCELLUS BLUECROSS BLUESHIELD |
| Plan identification number | 001 |
| 401k Plan Type | Other Pension Benefit |
| Plan Features/Benefits |
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| Company Name: | BLUE HERON CONSTRUCTION |
| Employer identification number (EIN): | 161571385 |
| NAIC Classification: | 237990 |
| NAIC Description: | Other Heavy and Civil Engineering Construction |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 001 | 2013-01-01 | JENNIFER KREISLER | JENNIFER KREISLER | 2014-08-07 |
| 2013: EXCELLUS BLUECROSS BLUESHIELD 2013 form 5500 responses | ||
|---|---|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
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