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| Plan Name | BLAZER ELECTRIC SUPPLY MANAGMENT COMPANY HEALTH PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BLAZER ELECTRIC SUPPLY MANAGEMENT COMPANY |
| Employer identification number (EIN): | 943482972 |
| NAIC Classification: | 423600 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-06-01 | JOSH ROWLEY | 2023-12-05 |
| Measure | Date | Value |
|---|---|---|
| 2022: BLAZER ELECTRIC SUPPLY MANAGMENT COMPANY HEALTH PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-06-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 81 |
| Number of retired or separated participants receiving benefits | 2022-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-06-01 | 0 |
| Total of all active and inactive participants | 2022-06-01 | 81 |
| Number of employers contributing to the scheme | 2022-06-01 | 0 |
| 2022: BLAZER ELECTRIC SUPPLY MANAGMENT COMPANY HEALTH PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | First time form 5500 has been submitted | Yes |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30033482 |
| Policy instance | 1 |
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) | |
| Policy contract number | 11275 |
| Policy instance | 2 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 618953 |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 881120G |
| Policy instance | 4 |
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