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| Plan Name | COBRA STONE INC EMPLOYEE GROUP HEALTH PLAN |
| Plan identification number | 601 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | COBRA STONE INC |
| Employer identification number (EIN): | 204628307 |
| NAIC Classification: | 212310 |
| NAIC Description: | Stone Mining and Quarrying |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 601 | 2017-01-01 | KRISTY CORTEZ |
| Measure | Date | Value |
|---|---|---|
| 2017: COBRA STONE INC EMPLOYEE GROUP HEALTH PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 67 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 53 |
| Total of all active and inactive participants | 2017-01-01 | 53 |
| Total participants | 2017-01-01 | 53 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 14 |
| Number of employers contributing to the scheme | 2017-01-01 | 2 |
| 2017: COBRA STONE INC EMPLOYEE GROUP HEALTH 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 |
| ALLIED NATIONAL COMPANIES (National Association of Insurance Commissioners NAIC id number: 60739 ) | |
| Policy contract number | 281383 2/3 |
| Policy instance | 1 |
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