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| Plan Name | SYSTEM SERVICES BLUE CROSS BLUE SHIELD |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SYSTEM SERVICES BROADBAND, INC. |
| Employer identification number (EIN): | 721469818 |
| NAIC Classification: | 221500 |
Additional information about SYSTEM SERVICES BROADBAND, INC.
| Jurisdiction of Incorporation: | Texas Secretary of State |
| Incorporation Date: | 2009-10-23 |
| Company Identification Number: | 0801185481 |
| Legal Registered Office Address: |
1830 W WILLOW ST SCOTT United States of America (USA) 70583 |
More information about SYSTEM SERVICES BROADBAND, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-01-01 | ||||
| 501 | 2021-01-01 | ||||
| 501 | 2020-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2022: SYSTEM SERVICES BLUE CROSS BLUE SHIELD 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 124 |
| Total of all active and inactive participants | 2022-01-01 | 124 |
| Total participants | 2022-01-01 | 124 |
| 2021: SYSTEM SERVICES BLUE CROSS BLUE SHIELD 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 110 |
| Total of all active and inactive participants | 2021-01-01 | 110 |
| Total participants | 2021-01-01 | 110 |
| 2020: SYSTEM SERVICES BLUE CROSS BLUE SHIELD 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 121 |
| Total of all active and inactive participants | 2020-01-01 | 121 |
| Total participants | 2020-01-01 | 121 |
| 2022: SYSTEM SERVICES BLUE CROSS BLUE SHIELD 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: SYSTEM SERVICES BLUE CROSS BLUE SHIELD 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: SYSTEM SERVICES BLUE CROSS BLUE SHIELD 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | First time form 5500 has been submitted | Yes |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 78772ERC | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 78772ERC | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 78772ERC | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 004463 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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