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Plan Name | PRO-FORM LABORATORIES MEDICAL, DENTAL, VISION, LIFE AND AD&D PLAN |
Plan identification number | 501 |
401k Plan Type | Welfare Benefit |
Plan Features/Benefits |
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Company Name: | PRO-FORM MANUFACTURING LLC DBA PRO-FORM LABORATORIES |
Employer identification number (EIN): | 943237141 |
NAIC Classification: | 424400 |
Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
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501 | 2017-06-01 | JEFF MITCHELL | |||
501 | 2016-06-01 | JEFF MITCHELL | |||
501 | 2015-06-01 | DAVID HENDRICKSON |
Measure | Date | Value |
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2017: PRO-FORM LABORATORIES MEDICAL, DENTAL, VISION, LIFE AND AD&D PLAN 2017 401k membership | ||
Total participants, beginning-of-year | 2017-06-01 | 157 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 177 |
Number of retired or separated participants receiving benefits | 2017-06-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
Total of all active and inactive participants | 2017-06-01 | 179 |
2016: PRO-FORM LABORATORIES MEDICAL, DENTAL, VISION, LIFE AND AD&D PLAN 2016 401k membership | ||
Total participants, beginning-of-year | 2016-06-01 | 151 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 173 |
Number of retired or separated participants receiving benefits | 2016-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-06-01 | 0 |
Total of all active and inactive participants | 2016-06-01 | 173 |
2015: PRO-FORM LABORATORIES MEDICAL, DENTAL, VISION, LIFE AND AD&D PLAN 2015 401k membership | ||
Total participants, beginning-of-year | 2015-06-01 | 132 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 146 |
Number of retired or separated participants receiving benefits | 2015-06-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2015-06-01 | 0 |
Total of all active and inactive participants | 2015-06-01 | 148 |
2017: PRO-FORM LABORATORIES MEDICAL, DENTAL, VISION, LIFE AND AD&D PLAN 2017 form 5500 responses | ||
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2017-06-01 | Type of plan entity | Single employer plan |
2017-06-01 | Submission has been amended | No |
2017-06-01 | This submission is the final filing | No |
2017-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-06-01 | Plan is a collectively bargained plan | No |
2017-06-01 | Plan funding arrangement – Insurance | Yes |
2017-06-01 | Plan benefit arrangement – Insurance | Yes |
2016: PRO-FORM LABORATORIES MEDICAL, DENTAL, VISION, LIFE AND AD&D PLAN 2016 form 5500 responses | ||
2016-06-01 | Type of plan entity | Single employer plan |
2016-06-01 | Submission has been amended | No |
2016-06-01 | This submission is the final filing | No |
2016-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-06-01 | Plan is a collectively bargained plan | No |
2016-06-01 | Plan funding arrangement – Insurance | Yes |
2016-06-01 | Plan benefit arrangement – Insurance | Yes |
2015: PRO-FORM LABORATORIES MEDICAL, DENTAL, VISION, LIFE AND AD&D PLAN 2015 form 5500 responses | ||
2015-06-01 | Type of plan entity | Single employer plan |
2015-06-01 | First time form 5500 has been submitted | Yes |
2015-06-01 | Submission has been amended | No |
2015-06-01 | This submission is the final filing | No |
2015-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-06-01 | Plan is a collectively bargained plan | No |
2015-06-01 | Plan funding arrangement – Insurance | Yes |
2015-06-01 | Plan benefit arrangement – Insurance | Yes |
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy contract number | 706937 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy contract number | 874546G | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy contract number | 907167-000,099 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy contract number | 907167-001,199 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy contract number | 30049029 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Policy instance | 5 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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