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| Plan Name | PREPAID DENTAL CARE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | TEMPUR-PEDIC MANAGEMENT, LLC |
| Employer identification number (EIN): | 611364709 |
| NAIC Classification: | 551112 |
| NAIC Description: | Offices of Other Holding Companies |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2012-09-01 | DALE WILLIAMS | |||
| 502 | 2011-09-01 | DALE WILLIAMS | |||
| 502 | 2009-09-01 | DALE WILLIAMS |
| Measure | Date | Value |
|---|---|---|
| 2012: PREPAID DENTAL CARE PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-09-01 | 668 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 0 |
| Number of retired or separated participants receiving benefits | 2012-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-09-01 | 0 |
| Total of all active and inactive participants | 2012-09-01 | 0 |
| 2011: PREPAID DENTAL CARE PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-09-01 | 648 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 668 |
| Number of retired or separated participants receiving benefits | 2011-09-01 | 19 |
| Number of other retired or separated participants entitled to future benefits | 2011-09-01 | 0 |
| Total of all active and inactive participants | 2011-09-01 | 687 |
| 2009: PREPAID DENTAL CARE PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-09-01 | 522 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 563 |
| Number of retired or separated participants receiving benefits | 2009-09-01 | 9 |
| Number of other retired or separated participants entitled to future benefits | 2009-09-01 | 0 |
| Total of all active and inactive participants | 2009-09-01 | 572 |
| 2012: PREPAID DENTAL CARE PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Submission has been amended | No |
| 2012-09-01 | This submission is the final filing | Yes |
| 2012-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2012-09-01 | Plan is a collectively bargained plan | No |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: PREPAID DENTAL CARE PLAN 2011 form 5500 responses | ||
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Submission has been amended | No |
| 2011-09-01 | This submission is the final filing | No |
| 2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-09-01 | Plan is a collectively bargained plan | No |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: PREPAID DENTAL CARE PLAN 2009 form 5500 responses | ||
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Submission has been amended | No |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-09-01 | Plan is a collectively bargained plan | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) | |||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 000689090 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) | |||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 000689090 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) | |||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 000689090 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||
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