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| Plan Name | GREENFIELD REHABILITATION AGENCY DENTAL PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GREENFIELD REHABILITATION AGENCY, INC. |
| Employer identification number (EIN): | 391385825 |
| NAIC Classification: | 621340 |
| NAIC Description: | Offices of Physical, Occupational and Speech Therapists, and Audiologists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2018-06-01 | MICHELLE POOLE | 2019-12-19 | ||
| 503 | 2017-06-01 |
| Measure | Date | Value |
|---|---|---|
| 2018: GREENFIELD REHABILITATION AGENCY DENTAL PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-06-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 140 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 140 |
| Number of employers contributing to the scheme | 2018-06-01 | 0 |
| 2017: GREENFIELD REHABILITATION AGENCY DENTAL PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-06-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 122 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 122 |
| 2018: GREENFIELD REHABILITATION AGENCY DENTAL PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: GREENFIELD REHABILITATION AGENCY DENTAL PLAN 2017 form 5500 responses | ||
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | First time form 5500 has been submitted | Yes |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) | |||||||||||||||||||||||||||
| Policy contract number | 140577 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) | |||||||||||||||||||||||||||
| Policy contract number | 140577 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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