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| Plan Name | BLACKHAWK STATE BANK DENTAL PLAN |
| Plan identification number | 006 |
| Company Name: | BLACKHAWK BANK |
| Employer identification number (EIN): | 390159130 |
| NAIC Classification: | 551111 |
| NAIC Description: | Offices of Bank Holding Companies |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 006 | 2009-01-01 | PATRICIA MCCOY |
| Measure | Date | Value |
|---|---|---|
| 2009: BLACKHAWK STATE BANK DENTAL PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 96 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 94 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 94 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 94 |
| 2009: BLACKHAWK STATE BANK DENTAL PLAN 2009 form 5500 responses | ||
|---|---|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | First time form 5500 has been submitted | Yes |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
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