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| Plan Name | ALTA CIMA CORP. GROUP LIFE INSURANCE PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ALTA CIMA CORP. |
| Employer identification number (EIN): | 860976798 |
| NAIC Classification: | 453930 |
| NAIC Description: | Manufactured (Mobile) Home Dealers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2021-01-01 | MANNY BACA | 2022-09-15 |
| 2021: ALTA CIMA CORP. GROUP LIFE INSURANCE PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) | |
| Policy contract number | 38666 |
| Policy instance | 1 |
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