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| Plan Name | CAMPMOR, INC. HEALTH AND PRESCRIPTION DRUG PLAN |
| Plan identification number | 513 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CAMPMOR, INC. |
| Employer identification number (EIN): | 222016846 |
| NAIC Classification: | 451110 |
| NAIC Description: | Sporting Goods Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 513 | 2017-06-01 | DANIEL JARASHOW | DANIEL JARASHOW | 2018-10-10 | |
| 513 | 2016-06-01 | DANIEL JARASHOW | DANIEL JARASHOW | 2017-10-04 |
| Measure | Date | Value |
|---|---|---|
| 2017: CAMPMOR, INC. HEALTH AND PRESCRIPTION DRUG PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-06-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 45 |
| Total of all active and inactive participants | 2017-06-01 | 45 |
| Total participants | 2017-06-01 | 45 |
| 2016: CAMPMOR, INC. HEALTH AND PRESCRIPTION DRUG PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-06-01 | 66 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 66 |
| Total of all active and inactive participants | 2016-06-01 | 66 |
| Total participants | 2016-06-01 | 66 |
| 2017: CAMPMOR, INC. HEALTH AND PRESCRIPTION DRUG PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: CAMPMOR, INC. HEALTH AND PRESCRIPTION DRUG PLAN 2016 form 5500 responses | ||
| 2016-06-01 | Type of plan entity | Single employer plan |
| 2016-06-01 | First time form 5500 has been submitted | Yes |
| 2016-06-01 | Plan funding arrangement – Insurance | Yes |
| 2016-06-01 | Plan benefit arrangement – Insurance | Yes |
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) | |||||||||||||||||||||||||||
| Policy contract number | 801J9 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) | |||||||||||||||||||||||||||
| Policy contract number | 801J9 | ||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||
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