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| Plan Name | BONE DRY ROOFING DENTAL PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BONE DRY ROOFING, INC. |
| Employer identification number (EIN): | 351883225 |
| NAIC Classification: | 236110 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2022-01-01 | JEFF RUSSELL | 2024-08-13 | ||
| 502 | 2021-01-01 | JEFF RUSSELL | 2024-08-13 | ||
| 502 | 2020-01-01 | JEFF RUSSELL | 2024-08-13 | ||
| 502 | 2019-01-01 | JEFF RUSSELL | 2024-08-13 | ||
| 502 | 2018-01-01 | JEFF RUSSELL | 2024-08-13 |
| 2022: BONE DRY ROOFING DENTAL 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 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: BONE DRY ROOFING DENTAL PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: BONE DRY ROOFING DENTAL PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: BONE DRY ROOFING DENTAL PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: BONE DRY ROOFING DENTAL PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) | |||||||||||||||||
| Policy contract number | 601 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) | |||||||||||||||||
| Policy contract number | 601 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) | |||||||||||||||||
| Policy contract number | 601 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) | |||||||||||||||||
| Policy contract number | 601 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) | |||||||||||||||||
| Policy contract number | 601 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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