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| Plan Name | PREMIER AUTOMATION HOLDINGS, INC. HEALTH PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PREMIER AUTOMATION |
| Employer identification number (EIN): | 204309879 |
| NAIC Classification: | 335310 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2017-10-01 | WALTER J DOLLARD | 2019-04-30 |
| Measure | Date | Value |
|---|---|---|
| 2017: PREMIER AUTOMATION HOLDINGS, INC. HEALTH PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-10-01 | 102 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 0 |
| 2017: PREMIER AUTOMATION HOLDINGS, INC. HEALTH PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | First time form 5500 has been submitted | Yes |
| 2017-10-01 | This submission is the final filing | Yes |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) | |||||||||||||||||||
| Policy contract number | 019361300 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) | |||||||||||||||||||
| Policy contract number | 019361301 | ||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||
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| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) | |||||||||||||||||||
| Policy contract number | 019361900 | ||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||
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