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| Plan Name | WALSTROM MARINE MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | WALSTROM MARINE, INC. |
| Employer identification number (EIN): | 381240624 |
| NAIC Classification: | 713900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | JESSICA KARR | 2024-07-11 |
| 2023: WALSTROM MARINE MEDICAL PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | First time form 5500 has been submitted | Yes |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |||||||||||||||||
| Policy contract number | 245448 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |||||||||||||||||
| Policy contract number | 245448 | ||||||||||||||||
| Policy instance | 2 | ||||||||||||||||
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