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| Plan Name | FOREMAN BROS.,INC. WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FOREMAN BROS., INC. |
| Employer identification number (EIN): | 381402251 |
| NAIC Classification: | 484200 |
| NAIC Description: | Specialized Freight Trucking |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-04-01 | SARA TUBBS |
| Measure | Date | Value |
|---|---|---|
| 2017: FOREMAN BROS.,INC. WELFARE BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-04-01 | 102 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 100 |
| Total of all active and inactive participants | 2017-04-01 | 100 |
| 2017: FOREMAN BROS.,INC. WELFARE BENEFIT PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | Submission has been amended | No |
| 2017-04-01 | This submission is the final filing | No |
| 2017-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-04-01 | Plan is a collectively bargained plan | No |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 104451 |
| Policy instance | 1 |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |
| Policy contract number | 010041847 |
| Policy instance | 2 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 104451 |
| Policy instance | 3 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | EAB1000018 |
| Policy instance | 4 |
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