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| Plan Name | BITTERCREEK RED FEATHER LLC HEALTH AND WELFARE WRAP PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BITTERCREEK RED FEATHER LLC |
| Employer identification number (EIN): | 203619018 |
| NAIC Classification: | 722511 |
| NAIC Description: | Full-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2022-10-01 | JAMI ADAMS | 2024-03-01 | JAMI ADAMS | 2024-03-01 |
| 502 | 2021-10-01 | JAMI ADAMS | 2023-03-16 | JAMI ADAMS | 2023-03-16 |
| Measure | Date | Value |
|---|---|---|
| 2022: BITTERCREEK RED FEATHER LLC HEALTH AND WELFARE WRAP PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-10-01 | 44 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 40 |
| Number of retired or separated participants receiving benefits | 2022-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-10-01 | 11 |
| Total of all active and inactive participants | 2022-10-01 | 51 |
| 2021: BITTERCREEK RED FEATHER LLC HEALTH AND WELFARE WRAP PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-10-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 38 |
| Number of retired or separated participants receiving benefits | 2021-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 0 |
| Total of all active and inactive participants | 2021-10-01 | 38 |
| 2022: BITTERCREEK RED FEATHER LLC HEALTH AND WELFARE WRAP PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | Submission has been amended | No |
| 2022-10-01 | This submission is the final filing | No |
| 2022-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-10-01 | Plan is a collectively bargained plan | No |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: BITTERCREEK RED FEATHER LLC HEALTH AND WELFARE WRAP PLAN 2021 form 5500 responses | ||
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | First time form 5500 has been submitted | Yes |
| 2021-10-01 | Submission has been amended | No |
| 2021-10-01 | This submission is the final filing | No |
| 2021-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-10-01 | Plan is a collectively bargained plan | No |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5746 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GV-4743 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GV-4743 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5746 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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