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| Plan Name | FOREST DENTAL PRODUCTS EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FOREST DENTAL PRODUCTS, INC. |
| Employer identification number (EIN): | 930692927 |
| NAIC Classification: | 339110 |
Additional information about FOREST DENTAL PRODUCTS, INC.
| Jurisdiction of Incorporation: | Oregon Secretary of State Corporations Division |
| Incorporation Date: | 1977-04-27 |
| Company Identification Number: | 12091419 |
| Legal Registered Office Address: |
3838 SW 52ND PLACE PORTLAND United States of America (USA) 97221 |
More information about FOREST DENTAL PRODUCTS, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-03-01 | MISTY BENDER | |||
| 501 | 2017-03-01 |
| Measure | Date | Value |
|---|---|---|
| 2017: FOREST DENTAL PRODUCTS EMPLOYEE BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-03-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 94 |
| Number of retired or separated participants receiving benefits | 2017-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-03-01 | 1 |
| Total of all active and inactive participants | 2017-03-01 | 95 |
| Total participants | 2017-03-01 | 95 |
| 2017: FOREST DENTAL PRODUCTS EMPLOYEE BENEFIT PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-03-01 | Type of plan entity | Multi-employer plan |
| 2017-03-01 | First time form 5500 has been submitted | Yes |
| 2017-03-01 | Submission has been amended | No |
| 2017-03-01 | This submission is the final filing | No |
| 2017-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-03-01 | Plan is a collectively bargained plan | No |
| 2017-03-01 | Plan funding arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 10158154 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 608240 |
| Policy instance | 2 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 10-31559 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 608240 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 608445 |
| Policy instance | 5 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) | |
| Policy contract number | 16937 |
| Policy instance | 6 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | R0534727 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 608241 |
| Policy instance | 4 |
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