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| Plan Name | REFRESH MANAGEMENT, LLC DENTAL AND VISION PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | REFRESH MANAGEMENT LLC |
| Employer identification number (EIN): | 474241017 |
| NAIC Classification: | 621112 |
| NAIC Description: | Offices of Physicians, Mental Health Specialists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-06-01 | JEFFREY F. SCALES | 2022-03-11 | ||
| 501 | 2018-06-01 | LOUIS JOOS | 2019-12-18 | ||
| 501 | 2018-06-01 | LOUIS JOOS | 2020-12-21 |
| 2020: REFRESH MANAGEMENT, LLC DENTAL AND VISION PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | First time form 5500 has been submitted | Yes |
| 2020-06-01 | Submission has been amended | No |
| 2020-06-01 | This submission is the final filing | Yes |
| 2020-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-06-01 | Plan is a collectively bargained plan | No |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: REFRESH MANAGEMENT, LLC DENTAL AND VISION PLAN 2018 form 5500 responses | ||
| 2018-06-01 | Type of plan entity | Mulitple employer plan |
| 2018-06-01 | First time form 5500 has been submitted | Yes |
| 2018-06-01 | Submission has been amended | No |
| 2018-06-01 | This submission is the final filing | No |
| 2018-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-06-01 | Plan is a collectively bargained plan | No |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | S8486 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | S8486 |
| Policy instance | 2 |
| RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61700 ) | |
| Policy contract number | 8644 |
| Policy instance | 3 |
| RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61700 ) | |
| Policy contract number | 8552 |
| Policy instance | 2 |
| RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61700 ) | |
| Policy contract number | 0008552 |
| Policy instance | 1 |
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