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| Plan Name | COMMUNITY ACTION PROGRAM - DENTAL & VISION PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | COMMUNITY ACTION PROGRAM - BELKNAP MERRIMACK COUNTIES INC. |
| Employer identification number (EIN): | 020270376 |
| NAIC Classification: | 624200 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2022-01-01 | JEANNE AGRI | 2022-12-22 | ||
| 504 | 2021-01-01 | JEANNE AGRI | 2022-10-14 |
| 2022: COMMUNITY ACTION PROGRAM - DENTAL & VISION PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | This submission is the final filing | Yes |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: COMMUNITY ACTION PROGRAM - DENTAL & VISION 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 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) | |
| Policy contract number | 13650 |
| Policy instance | 1 |
| RED TREE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 13646 ) | |
| Policy contract number | 913650 |
| Policy instance | 2 |
| NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) | |
| Policy contract number | 13650 |
| Policy instance | 1 |
| RED TREE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 13646 ) | |
| Policy contract number | 913650 |
| Policy instance | 2 |
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