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| Plan Name | ASHTABULA RUBBER CO GROUP HEALTH INSURANCE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ASHTABULA RUBBER COMPANY |
| Employer identification number (EIN): | 340646833 |
| NAIC Classification: | 326200 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2013-04-01 | BOB FRISCIC | 2015-01-14 | BOB FRISCIC | 2015-01-14 |
| 501 | 2012-04-01 | BOB FRISCIC | BOB FRISCIC | 2013-10-09 | |
| 501 | 2011-01-01 | BOB FRISCIC | BOB FRISCIC | 2013-01-10 |
| Measure | Date | Value |
|---|---|---|
| 2012: ASHTABULA RUBBER CO GROUP HEALTH INSURANCE PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-04-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 103 |
| Number of retired or separated participants receiving benefits | 2012-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-04-01 | 0 |
| Total of all active and inactive participants | 2012-04-01 | 103 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-04-01 | 0 |
| Total participants | 2012-04-01 | 103 |
| 2011: ASHTABULA RUBBER CO GROUP HEALTH INSURANCE PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-01-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 109 |
| Total of all active and inactive participants | 2011-01-01 | 109 |
| Total participants | 2011-01-01 | 109 |
| 2012: ASHTABULA RUBBER CO GROUP HEALTH INSURANCE PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | Submission has been amended | No |
| 2012-04-01 | This submission is the final filing | No |
| 2012-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-04-01 | Plan is a collectively bargained plan | No |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ASHTABULA RUBBER CO GROUP HEALTH INSURANCE PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 ) | |||||||||||||||||||||
| Policy contract number | |||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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| MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 ) | |||||||||||||||||||||
| Policy contract number | |||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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