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| Plan Name | BCBS JFS PPO |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | JEWISH FAMILY SERVICE OF METROPOLITAN DETROIT |
| Employer identification number (EIN): | 380691329 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2015-01-01 | BRETT NICHOLSON | BRETT NICHOLSON | 2016-05-09 | |
| 504 | 2015-01-01 | AMY HAIMANN | 2024-11-25 |
| 2015: BCBS JFS PPO 2015 form 5500 responses | ||
|---|---|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | First time form 5500 has been submitted | Yes |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |||||||||||||||||||
| Policy contract number | 65079-556 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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