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| Plan Name | BOCCHI LABORATORIES MEDICAL PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SHADOW HOLDINGS, LLC DBA BRIGHT INNOVATION LABS |
| Employer identification number (EIN): | 261455829 |
| NAIC Classification: | 424210 |
| NAIC Description: | Drugs and Druggists' Sundries Merchant Wholesalers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2022-06-01 | KYLE CLINE | 2023-10-12 | ||
| 504 | 2018-06-01 | MICHAEL HUGHES | 2020-03-10 | ||
| 504 | 2016-06-01 |
| 2022: BOCCHI LABORATORIES MEDICAL PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: BOCCHI LABORATORIES MEDICAL PLAN 2018 form 5500 responses | ||
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: BOCCHI LABORATORIES MEDICAL 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 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||
| Policy contract number | 226397 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||
| Policy contract number | 226397 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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