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| Plan Name | BUSHTEX INC. HEALTH AND WELFARE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BUSHTEX INC |
| Employer identification number (EIN): | 200132017 |
| NAIC Classification: | 517000 |
Additional information about BUSHTEX INC
| Jurisdiction of Incorporation: | Arizona Corporation Commission |
| Incorporation Date: | |
| Company Identification Number: | 10852460 |
More information about BUSHTEX INC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | ADELAIDA SEVERSON | 2024-08-12 | ||
| 501 | 2022-01-01 | ADELAIDA SEVERSON | 2023-07-21 |
| Measure | Date | Value |
|---|---|---|
| 2023: BUSHTEX INC. HEALTH AND WELFARE BENEFITS PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-01-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 19 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| 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 | 19 |
| 2022: BUSHTEX INC. HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 30 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 38 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 38 |
| 2023: BUSHTEX INC. HEALTH AND WELFARE BENEFITS PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 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 |
| 2022: BUSHTEX INC. HEALTH AND WELFARE BENEFITS PLAN 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | First time form 5500 has been submitted | Yes |
| 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 funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| ALL SAVERS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82406 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1418332 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 4699 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 4699V | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| ALL SAVERS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82406 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1418332 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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