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| Plan Name | BERKELEY CITIZENS, INC. CAFETERIA PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BERKELEY CITIZENS, INC. |
| Employer identification number (EIN): | 570698682 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2002-07-01 | ALICE E SHOOK |
| 2002: BERKELEY CITIZENS, INC. CAFETERIA PLAN 2002 form 5500 responses | ||
|---|---|---|
| 2002-07-01 | Type of plan entity | Single employer plan |
| 2002-07-01 | Submission has been amended | Yes |
| 2002-07-01 | This submission is the final filing | Yes |
| 2002-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-07-01 | Plan is a collectively bargained plan | No |
| 2002-07-01 | Plan funding arrangement – Insurance | Yes |
| 2002-07-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) | |
| Policy contract number | 25-52768-00 |
| Policy instance | 1 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) | |
| Policy contract number | 602-25-38573-00 |
| Policy instance | 2 |
| BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 ) | |
| Policy contract number | BA100/BA970 |
| Policy instance | 3 |
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