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| Plan Name | GRAHAM ENTERPRISE DENTAL |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GRAHAM ENTERPRISE, INC. |
| Employer identification number (EIN): | 363728266 |
| NAIC Classification: | 447100 |
| NAIC Description: | Gasoline Stations, Gas |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2021-10-01 | ||||
| 502 | 2021-10-01 | KEVIN OBRIEN | |||
| 502 | 2020-10-01 | KEVIN O'BRIEN | 2022-02-16 | ||
| 502 | 2019-10-01 | JOHN C. GRAHAM | 2021-02-09 | ||
| 502 | 2018-10-01 | JOHN GRAHAM | 2020-04-01 |
| 2021: GRAHAM ENTERPRISE DENTAL 2021 form 5500 responses | ||
|---|---|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Submission has been amended | No |
| 2021-10-01 | This submission is the final filing | No |
| 2021-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-10-01 | Plan is a collectively bargained plan | No |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: GRAHAM ENTERPRISE DENTAL 2020 form 5500 responses | ||
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: GRAHAM ENTERPRISE DENTAL 2019 form 5500 responses | ||
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: GRAHAM ENTERPRISE DENTAL 2018 form 5500 responses | ||
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | First time form 5500 has been submitted | Yes |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 3344583 |
| Policy instance | 1 |
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |
| Policy contract number | 678148 |
| Policy instance | 1 |
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |
| Policy contract number | 678148 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 210540 |
| Policy instance | 1 |
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