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| Plan Name | DELTA DENTAL PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | AFC SPECIALTY COATINGS GROUP, INC. |
| Employer identification number (EIN): | 363580228 |
| NAIC Classification: | 314000 |
| NAIC Description: | Textile Product Mills |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2018-09-01 | ||||
| 503 | 2017-09-01 | JANELLE LEDGERWOOD | |||
| 503 | 2016-09-01 | JANELLE LEDGERWOOD |
| Measure | Date | Value |
|---|---|---|
| 2018: DELTA DENTAL PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-09-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 83 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 0 |
| Total of all active and inactive participants | 2018-09-01 | 83 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-09-01 | 0 |
| Total participants | 2018-09-01 | 83 |
| Number of employers contributing to the scheme | 2018-09-01 | 0 |
| 2017: DELTA DENTAL PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-09-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 101 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 0 |
| Total of all active and inactive participants | 2017-09-01 | 101 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-09-01 | 0 |
| Total participants | 2017-09-01 | 101 |
| Number of participants with account balances | 2017-09-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-09-01 | 0 |
| Number of employers contributing to the scheme | 2017-09-01 | 0 |
| 2016: DELTA DENTAL PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-09-01 | 82 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 102 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 102 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-09-01 | 0 |
| Total participants | 2016-09-01 | 102 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-09-01 | 0 |
| Number of employers contributing to the scheme | 2016-09-01 | 0 |
| 2018: DELTA DENTAL PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Submission has been amended | No |
| 2018-09-01 | This submission is the final filing | No |
| 2018-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-09-01 | Plan is a collectively bargained plan | No |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: DELTA DENTAL PLAN 2017 form 5500 responses | ||
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Submission has been amended | No |
| 2017-09-01 | This submission is the final filing | No |
| 2017-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-09-01 | Plan is a collectively bargained plan | No |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: DELTA DENTAL PLAN 2016 form 5500 responses | ||
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | First time form 5500 has been submitted | Yes |
| 2016-09-01 | Submission has been amended | No |
| 2016-09-01 | This submission is the final filing | No |
| 2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-09-01 | Plan is a collectively bargained plan | No |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 11329 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 11329 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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