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| Plan Name | PREPAID DENTAL CARE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | HUNGER MOUNTAIN COOPERATIVE, INC. |
| Employer identification number (EIN): | 030229475 |
| NAIC Classification: | 445110 |
| NAIC Description: | Supermarkets and Other Grocery (except Convenience) Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2015-07-01 | ||||
| 502 | 2014-07-01 |
| Measure | Date | Value |
|---|---|---|
| 2015: PREPAID DENTAL CARE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-07-01 | 104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 110 |
| Total of all active and inactive participants | 2015-07-01 | 110 |
| 2014: PREPAID DENTAL CARE PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-07-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 104 |
| Total of all active and inactive participants | 2014-07-01 | 104 |
| 2015: PREPAID DENTAL CARE PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | This submission is the final filing | Yes |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: PREPAID DENTAL CARE PLAN 2014 form 5500 responses | ||
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | First time form 5500 has been submitted | Yes |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL PLAN OF VERMONT, INC. (National Association of Insurance Commissioners NAIC id number: 53279 ) | |||||||||||||||||||||||||||||
| Policy contract number | 000070048 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
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| DELTA DENTAL PLAN OF VERMONT, INC. (National Association of Insurance Commissioners NAIC id number: 53279 ) | |||||||||||||||||||||||||||||
| Policy contract number | 000070048 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
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