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| Plan Name | GROUP DENTAL INSURANCE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | WELLSPRING FAMILY SERVICES |
| Employer identification number (EIN): | 910567261 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
Additional information about WELLSPRING FAMILY SERVICES
| Jurisdiction of Incorporation: | Washington Secretary of State Corporations Division |
| Incorporation Date: | 1922-04-03 |
| Company Identification Number: | 600351881 |
| Legal Registered Office Address: |
1450 5TH AVE STE 4200 SEATTLE United States of America (USA) 981012314 |
More information about WELLSPRING FAMILY SERVICES
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2022-01-01 | ||||
| 502 | 2022-01-01 | JENNAFER PRICE CARGILL | |||
| 502 | 2018-01-01 | BOB MENDONSA | BOB MENDONSA | 2019-05-07 | |
| 502 | 2017-01-01 | BOB MENDONSA | BOB MENDONSA | 2018-08-02 | |
| 502 | 2016-01-01 | BOB MENDONSA | BOB MENDONSA | 2017-07-27 |
| 2022: GROUP DENTAL INSURANCE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: GROUP DENTAL INSURANCE PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: GROUP DENTAL INSURANCE 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: GROUP DENTAL INSURANCE PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | First time form 5500 has been submitted | Yes |
| 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 |
| DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 07394 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 07394 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||
| DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 07394 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||
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