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| Plan Name | EVERGREEN LINEN SOLUTIONS MEDICAL, DENTAL, VISION PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | B & H PW, LLC DBA EVERGREEN LINEN SOLUTIONS |
| Employer identification number (EIN): | 814211004 |
| NAIC Classification: | 812330 |
| NAIC Description: | Linen and Uniform Supply |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-03-01 | SAMANTHA DIGIULIO | 2024-10-07 | ||
| 501 | 2022-03-01 | SAMANTHA DIGIULIO | 2023-09-18 |
| Measure | Date | Value |
|---|---|---|
| 2023: EVERGREEN LINEN SOLUTIONS MEDICAL, DENTAL, VISION PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-03-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-03-01 | 141 |
| Number of retired or separated participants receiving benefits | 2023-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-03-01 | 0 |
| Total of all active and inactive participants | 2023-03-01 | 141 |
| Number of employers contributing to the scheme | 2023-03-01 | 0 |
| 2022: EVERGREEN LINEN SOLUTIONS MEDICAL, DENTAL, VISION PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-03-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 132 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
| Total of all active and inactive participants | 2022-03-01 | 132 |
| Number of employers contributing to the scheme | 2022-03-01 | 0 |
| 2023: EVERGREEN LINEN SOLUTIONS MEDICAL, DENTAL, VISION PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-03-01 | Type of plan entity | Single employer plan |
| 2023-03-01 | Plan funding arrangement – Insurance | Yes |
| 2023-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: EVERGREEN LINEN SOLUTIONS MEDICAL, DENTAL, VISION PLAN 2022 form 5500 responses | ||
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | First time form 5500 has been submitted | Yes |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 14177141 | ||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 632413 | ||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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