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| Plan Name | DENTAL INSURANCE |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MAYFLOWER DISTRIBUTING CO. INC. |
| Employer identification number (EIN): | 411400806 |
| NAIC Classification: | 424990 |
| NAIC Description: | Other Miscellaneous Nondurable Goods Merchant Wholesalers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2021-01-01 |
| 2021: DENTAL INSURANCE 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| FORMULA BENEFITS (National Association of Insurance Commissioners NAIC id number: 52411 ) | |
| Policy contract number | 900224 |
| Policy instance | 1 |
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