| Plan Name | EAST BAY CLARKLIFT, INC. EMPLOYEES WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | EAST BAY CLARKLIFT, INC. |
| Employer identification number (EIN): | 943101700 |
| NAIC Classification: | 811310 |
| NAIC Description: | Commercial and Industrial Machinery and Equipment (except Automotive and Electronic) Repair and Maintenance |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-06-01 | ABRAHAM SHEWAREGED | |||
| 501 | 2016-06-01 | ABRAHAM SHEWAREGED |
| Measure | Date | Value |
|---|---|---|
| 2017: EAST BAY CLARKLIFT, INC. EMPLOYEES WELFARE BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-06-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 97 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 97 |
| 2016: EAST BAY CLARKLIFT, INC. EMPLOYEES WELFARE BENEFIT PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-06-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 135 |
| Number of retired or separated participants receiving benefits | 2016-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-06-01 | 0 |
| Total of all active and inactive participants | 2016-06-01 | 135 |
| 2017: EAST BAY CLARKLIFT, INC. EMPLOYEES WELFARE BENEFIT PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | Submission has been amended | No |
| 2017-06-01 | This submission is the final filing | No |
| 2017-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-06-01 | Plan is a collectively bargained plan | No |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: EAST BAY CLARKLIFT, INC. EMPLOYEES WELFARE BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-06-01 | Type of plan entity | Single employer plan |
| 2016-06-01 | First time form 5500 has been submitted | Yes |
| 2016-06-01 | Submission has been amended | No |
| 2016-06-01 | This submission is the final filing | No |
| 2016-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-06-01 | Plan is a collectively bargained plan | No |
| 2016-06-01 | Plan funding arrangement – Insurance | Yes |
| 2016-06-01 | Plan benefit arrangement – Insurance | Yes |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |
| Policy contract number | 280522 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 605235 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 305088 |
| Policy instance | 3 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0909863 |
| Policy instance | 4 |