| Plan Name | O2 SPECIALTY MANUFACTURING WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | O2 SPECIALTY MANUFACTURING |
| Employer identification number (EIN): | 800877148 |
| NAIC Classification: | 333900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-01-01 | ANN HARTMAN | |||
| 501 | 2016-04-01 | ANN HARTMAN | |||
| 501 | 2016-04-01 |
| 2017: O2 SPECIALTY MANUFACTURING WELFARE BENEFIT PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: O2 SPECIALTY MANUFACTURING WELFARE BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | First time form 5500 has been submitted | Yes |
| 2016-04-01 | Submission has been amended | Yes |
| 2016-04-01 | This submission is the final filing | No |
| 2016-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-04-01 | Plan is a collectively bargained plan | No |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 283102 |
| Policy instance | 1 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 283102 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 2415 |
| Policy instance | 3 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 8248 |
| Policy instance | 4 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |
| Policy contract number | G000AS7S |
| Policy instance | 5 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 8699 |
| Policy instance | 6 |