401k Plan data: BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN plan

BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN
Plan identification number	501

BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

BOTTOMLEY EVERGREENS AND FARMS, INC. has sponsored the creation of one or more 401k plans.

Company Name: BOTTOMLEY EVERGREENS AND FARMS, INC.

Employer identification number (EIN): 561957256

NAIC Classification: 113210
NAIC Description: Forest Nurseries and Gathering of Forest Products

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-06-01 EMILY CAVE 2024-03-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-06-01	EMILY CAVE	2024-03-14

Plan Statistics for BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN

Measure Date Value
2022: BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 128
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 214
Number of retired or separated participants receiving benefits 2022-06-01 0
Number of other retired or separated participants entitled to future benefits 2022-06-01 0
Total of all active and inactive participants 2022-06-01 214

Measure	Date	Value
2022: BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	128
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	214
Number of retired or separated participants receiving benefits	2022-06-01	0
Number of other retired or separated participants entitled to future benefits	2022-06-01	0
Total of all active and inactive participants	2022-06-01	214

Form 5500 Responses for BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN

2022: BOTTOMLEY EVERGREENS & FARMS, INC. EMPLOYEE BENEFITS PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	First time form 5500 has been submitted	Yes
2022-06-01	Submission has been amended	No
2022-06-01	This submission is the final filing	No
2022-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-06-01	Plan is a collectively bargained plan	No
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

STHEALTH/CHARTIS (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

CL-5219

Policy instance

Insurance contract or identification number	CL-5219
Number of Individuals Covered	183
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $272,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00037334

Policy instance

Insurance contract or identification number	00037334
Number of Individuals Covered	214
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $59,223
Total amount of fees paid to insurance company	USD $3,620
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D, ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $207,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,236
Amount paid for insurance broker fees	3620
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	BOTTOMLEY EVERGREENS AND FARMS, INC.
Employer identification number (EIN):	561957256
NAIC Classification:	113210
NAIC Description:	Forest Nurseries and Gathering of Forest Products