401k Plan data: MEDICAL PLAN plan

MEDICAL PLAN 401k Plan overview

Plan Name	MEDICAL PLAN
Plan identification number	501

MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

DEVILBISS HEALTHCARE has sponsored the creation of one or more 401k plans.

Company Name: DEVILBISS HEALTHCARE

Employer identification number (EIN): 264451080

NAIC Classification: 339110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 SUSAN CAMPBELL
501 2017-01-01
501 2016-01-01 SUSAN CAMPBELL SUSAN CAMPBELL 2017-07-31
501 2015-01-01 SUSAN CAMPBELL
501 2014-01-01 SUSAN CAMPBELL
501 2013-01-01 SUSAN CAMPBELL SUSAN CAMPBELL 2014-07-03
501 2012-01-01 SUSAN CAMPBELL SUSAN CAMPBELL 2013-07-19
501 2011-01-01 SUSAN CAMPBELL
501 2010-01-01 SUSAN CAMPBELL

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2017-01-01	SUSAN CAMPBELL
501	2017-01-01
501	2016-01-01	SUSAN CAMPBELL	SUSAN CAMPBELL	2017-07-31
501	2015-01-01	SUSAN CAMPBELL
501	2014-01-01	SUSAN CAMPBELL
501	2013-01-01	SUSAN CAMPBELL	SUSAN CAMPBELL	2014-07-03
501	2012-01-01	SUSAN CAMPBELL	SUSAN CAMPBELL	2013-07-19
501	2011-01-01	SUSAN CAMPBELL
501	2010-01-01	SUSAN CAMPBELL

Plan Statistics for MEDICAL PLAN

401k plan membership statisitcs for MEDICAL PLAN

Measure Date Value
2017: MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 80
Number of retired or separated participants receiving benefits 2017-01-01 1
Total of all active and inactive participants 2017-01-01 81
Total participants 2017-01-01 81
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
2016: MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 198
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 88
Number of retired or separated participants receiving benefits 2016-01-01 3
Total of all active and inactive participants 2016-01-01 91
Total participants 2016-01-01 91
2015: MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 194
Number of retired or separated participants receiving benefits 2015-01-01 4
Total of all active and inactive participants 2015-01-01 198
Total participants 2015-01-01 198
2014: MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 209
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 215
Number of retired or separated participants receiving benefits 2014-01-01 6
Total of all active and inactive participants 2014-01-01 221
Total participants 2014-01-01 221
2013: MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 201
Number of retired or separated participants receiving benefits 2013-01-01 8
Total of all active and inactive participants 2013-01-01 209
Total participants 2013-01-01 209
2012: MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 191
Number of retired or separated participants receiving benefits 2012-01-01 8
Total of all active and inactive participants 2012-01-01 199
Total participants 2012-01-01 199
2011: MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 209
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 198
Number of retired or separated participants receiving benefits 2011-01-01 10
Total of all active and inactive participants 2011-01-01 208
Total participants 2011-01-01 208
2010: MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 225
Number of retired or separated participants receiving benefits 2010-01-01 10
Total of all active and inactive participants 2010-01-01 235
Total participants 2010-01-01 235

Measure	Date	Value
2017: MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	80
Number of retired or separated participants receiving benefits	2017-01-01	1
Total of all active and inactive participants	2017-01-01	81
Total participants	2017-01-01	81
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
2016: MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	198
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	88
Number of retired or separated participants receiving benefits	2016-01-01	3
Total of all active and inactive participants	2016-01-01	91
Total participants	2016-01-01	91
2015: MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	194
Number of retired or separated participants receiving benefits	2015-01-01	4
Total of all active and inactive participants	2015-01-01	198
Total participants	2015-01-01	198
2014: MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	209
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	215
Number of retired or separated participants receiving benefits	2014-01-01	6
Total of all active and inactive participants	2014-01-01	221
Total participants	2014-01-01	221
2013: MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	201
Number of retired or separated participants receiving benefits	2013-01-01	8
Total of all active and inactive participants	2013-01-01	209
Total participants	2013-01-01	209
2012: MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	191
Number of retired or separated participants receiving benefits	2012-01-01	8
Total of all active and inactive participants	2012-01-01	199
Total participants	2012-01-01	199
2011: MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	209
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	198
Number of retired or separated participants receiving benefits	2011-01-01	10
Total of all active and inactive participants	2011-01-01	208
Total participants	2011-01-01	208
2010: MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	225
Number of retired or separated participants receiving benefits	2010-01-01	10
Total of all active and inactive participants	2010-01-01	235
Total participants	2010-01-01	235

Form 5500 Responses for MEDICAL PLAN

2017: MEDICAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MEDICAL PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MEDICAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MEDICAL PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MEDICAL PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MEDICAL PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MEDICAL PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: MEDICAL PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	First time form 5500 has been submitted	Yes
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

039135

Policy instance

Insurance contract or identification number	039135
Number of Individuals Covered	182
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	DEVILBISS HEALTHCARE
Employer identification number (EIN):	264451080
NAIC Classification:	339110