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| Plan Name | CAPFORM, INC. |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CAPFORM, INC. |
| Employer identification number (EIN): | 751677890 |
| NAIC Classification: | 238900 |
Additional information about CAPFORM, INC.
| Jurisdiction of Incorporation: | Texas Secretary of State |
| Incorporation Date: | 1979-12-17 |
| Company Identification Number: | 0050085700 |
| Legal Registered Office Address: |
PO BOX 111130 CARROLLTON United States of America (USA) 75011 |
More information about CAPFORM, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2016-08-01 | GLORIA WADE | |||
| 504 | 2015-08-01 | GLORIA WADE |
| 2016: CAPFORM, INC. 2016 form 5500 responses | ||
|---|---|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Submission has been amended | No |
| 2016-08-01 | This submission is the final filing | No |
| 2016-08-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-08-01 | Plan is a collectively bargained plan | No |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: CAPFORM, INC. 2015 form 5500 responses | ||
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Submission has been amended | No |
| 2015-08-01 | This submission is the final filing | No |
| 2015-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-08-01 | Plan is a collectively bargained plan | No |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 ) | |
| Policy contract number | KM05753637 |
| Policy instance | 1 |
| SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 ) | |
| Policy contract number | KM05753637 |
| Policy instance | 2 |
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