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| Plan Name | BLOOMFIELD HOMES HEALTH PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BLOOMFIELD HOMES |
| Employer identification number (EIN): | 743131013 |
| NAIC Classification: | 531320 |
| NAIC Description: | Offices of Real Estate Appraisers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-12-01 | JOHN MATNEY | 2023-08-09 |
| Measure | Date | Value |
|---|---|---|
| 2021: BLOOMFIELD HOMES HEALTH PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-12-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 123 |
| Number of retired or separated participants receiving benefits | 2021-12-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 6 |
| Total of all active and inactive participants | 2021-12-01 | 130 |
| Number of employers contributing to the scheme | 2021-12-01 | 0 |
| 2021: BLOOMFIELD HOMES HEALTH PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | First time form 5500 has been submitted | Yes |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |||||||||||||||||||||||||||||
| Policy contract number | 298942 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
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