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| Plan Name | OPPER MELANG RESTAURANTS GROUP HEALTH PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | OPPER MELANG RESTAURANTS |
| Employer identification number (EIN): | 203665640 |
| NAIC Classification: | 722511 |
| NAIC Description: | Full-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-01-01 | ERICA STIRN | 2020-07-14 | ||
| 501 | 2018-01-01 |
| 2019: OPPER MELANG RESTAURANTS GROUP HEALTH PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: OPPER MELANG RESTAURANTS GROUP HEALTH PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 ) | |
| Policy contract number | 4013063 |
| Policy instance | 1 |
| DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) | |
| Policy contract number | 13347 |
| Policy instance | 2 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) | |
| Policy contract number | 30024704 |
| Policy instance | 3 |
| PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 ) | |
| Policy contract number | 4013063 |
| Policy instance | 1 |
| DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) | |
| Policy contract number | 13347 |
| Policy instance | 2 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) | |
| Policy contract number | 30024704 |
| Policy instance | 3 |
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