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| Plan Name | GRAHAM COMPANIES GROUP DENTAL PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GRAHAM TIRE CO. |
| Employer identification number (EIN): | 460219484 |
| NAIC Classification: | 441300 |
| NAIC Description: | Automotive Parts, Accessories, and Tire Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2012-01-01 | DAVID OLIVER | |||
| 504 | 2011-01-01 | DAVID MICKELSON | |||
| 504 | 2009-01-01 | DAVID OLIVER |
| 2012: GRAHAM COMPANIES GROUP DENTAL PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GRAHAM COMPANIES GROUP DENTAL PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GRAHAM COMPANIES GROUP DENTAL PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 ) | |
| Policy contract number | 2491 |
| Policy instance | 1 |
| DELTA DENTAL PLAN OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: ) | |
| Policy contract number | 2491 |
| Policy instance | 1 |
| DELTA DENTAL OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 54097 ) | |
| Policy contract number | 2491 |
| Policy instance | 1 |
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