401k Plan data: MULTIFAB, INC. - MED, RX, VIS (PPO) plan

MULTIFAB, INC. - MED, RX, VIS (PPO) 401k Plan overview

Plan Name	MULTIFAB, INC. - MED, RX, VIS (PPO)
Plan identification number	503

MULTIFAB, INC. - MED, RX, VIS (PPO) Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Vision Other welfare benefit cover

401k Sponsoring company profile

MULTIFAB INC. has sponsored the creation of one or more 401k plans.

Company Name: MULTIFAB INC.

Employer identification number (EIN): 911392269

NAIC Classification: 326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MULTIFAB, INC. - MED, RX, VIS (PPO)

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2023-09-01 ROCHELLE MARSH
503 2021-09-01
503 2021-09-01 ROCHELLE MARSH
503 2020-09-01
503 2019-09-01
503 2015-09-01

Plan Statistics for MULTIFAB, INC. - MED, RX, VIS (PPO)

401k plan membership statisitcs for MULTIFAB, INC. - MED, RX, VIS (PPO)

Measure Date Value
2021: MULTIFAB, INC. - MED, RX, VIS (PPO) 2021 401k membership
Total participants, beginning-of-year 2021-09-01 95
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 93
Total of all active and inactive participants 2021-09-01 93
Total participants 2021-09-01 93
2020: MULTIFAB, INC. - MED, RX, VIS (PPO) 2020 401k membership
Total participants, beginning-of-year 2020-09-01 107
Total number of active participants reported on line 7a of the Form 5500 2020-09-01 95
Total of all active and inactive participants 2020-09-01 95
Total participants 2020-09-01 95
2019: MULTIFAB, INC. - MED, RX, VIS (PPO) 2019 401k membership
Total participants, beginning-of-year 2019-09-01 122
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 107
Total of all active and inactive participants 2019-09-01 107
Total participants 2019-09-01 107
2015: MULTIFAB, INC. - MED, RX, VIS (PPO) 2015 401k membership
Total participants, beginning-of-year 2015-09-01 112
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 121
Total of all active and inactive participants 2015-09-01 121
Total participants 2015-09-01 121

Measure	Date	Value
2021: MULTIFAB, INC. - MED, RX, VIS (PPO) 2021 401k membership
Total participants, beginning-of-year	2021-09-01	95
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	93
Total of all active and inactive participants	2021-09-01	93
Total participants	2021-09-01	93
2020: MULTIFAB, INC. - MED, RX, VIS (PPO) 2020 401k membership
Total participants, beginning-of-year	2020-09-01	107
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	95
Total of all active and inactive participants	2020-09-01	95
Total participants	2020-09-01	95
2019: MULTIFAB, INC. - MED, RX, VIS (PPO) 2019 401k membership
Total participants, beginning-of-year	2019-09-01	122
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	107
Total of all active and inactive participants	2019-09-01	107
Total participants	2019-09-01	107
2015: MULTIFAB, INC. - MED, RX, VIS (PPO) 2015 401k membership
Total participants, beginning-of-year	2015-09-01	112
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	121
Total of all active and inactive participants	2015-09-01	121
Total participants	2015-09-01	121

Form 5500 Responses for MULTIFAB, INC. - MED, RX, VIS (PPO)

2021: MULTIFAB, INC. - MED, RX, VIS (PPO) 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	Submission has been amended	No
2021-09-01	This submission is the final filing	No
2021-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-09-01	Plan is a collectively bargained plan	No
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes
2020: MULTIFAB, INC. - MED, RX, VIS (PPO) 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Submission has been amended	No
2020-09-01	This submission is the final filing	No
2020-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-09-01	Plan is a collectively bargained plan	No
2020-09-01	Plan funding arrangement – Insurance	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2019: MULTIFAB, INC. - MED, RX, VIS (PPO) 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Submission has been amended	No
2019-09-01	This submission is the final filing	No
2019-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-09-01	Plan is a collectively bargained plan	No
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2015: MULTIFAB, INC. - MED, RX, VIS (PPO) 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	1002161
Policy instance	1
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	1002161
Policy instance	1
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number	1002161
Policy instance	1

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Company Name:	MULTIFAB INC.
Employer identification number (EIN):	911392269
NAIC Classification:	326100

Plan id#	Filing Submission Date	Name of Administrator
503	2023-09-01	ROCHELLE MARSH
503	2021-09-01
503	2021-09-01	ROCHELLE MARSH
503	2020-09-01
503	2019-09-01
503	2015-09-01