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| Plan Name | BRIDGEWATER BANK HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BRIDGEWATER BANK |
| Employer identification number (EIN): | 030572894 |
| NAIC Classification: | 522110 |
| NAIC Description: | Commercial Banking |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2023-01-01 |
| Measure | Date | Value |
|---|---|---|
| 2023: BRIDGEWATER BANK HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-01-01 | 244 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 257 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 260 |
| 2023: BRIDGEWATER BANK HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | First time form 5500 has been submitted | Yes |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 28044 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 101150 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 30107650 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | G000C2VP | ||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||
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